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   Table of Contents - Current issue
Coverpage
April-June 2018
Volume 8 | Issue 2
Page Nos. 42-72

Online since Tuesday, July 3, 2018

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RESEARCH ARTICLES  

Comparing remifentanil, magnesium sulfate, and dexmedetomidine for intraoperative hypotension and bleeding and postoperative recovery in endoscopic sinus surgery and tympanomastoidectomy p. 42
Hesameddin Modir, Amirreza Modir, Omid Rezaei, Abolfazl Mohammadbeigi
DOI:10.4103/2045-9912.235124  
The study aimed to compare remifentanil, magnesium sulfate, and dexmedetomidine for intraoperative hypotension, bleeding volume, and recovery time in endoscopic sinus surgery and tympanomastoidectomy (TM). A double-blind clinical trial enrolled the patients undergoing endoscopic nasal sinus surgery and TM at Amirkabir Hospital (Arak, Iran), who were randomly assigned into three groups dexmedetomidine (DEX), remifentanil (REM), and magnesium sulfate (MgSO4) to which we intravenously administered 1 μg/kg DEX, an intravenous dose of 1 μg/kg REM, and 40 mg/kg of intravenous MgSO4, respectively. The blood loss, blood pressure (BP), heart ratio (HR), oxygen saturation (SaO2), and recovery time were recorded. Significant differences were found statistically in bleeding rates among all groups (P = 0.0001). The least amount of blood loss (very mild bleeding) was observed at 82.85% in the DEX group. BP and HR were lower in this group than those in the other groups. While recovery score was significantly different in the three groups (P = 0.007), the recovery time was the highest in the DEX group, while the least in the REM group. Based on the present results Dexmedetomidine seems to better prevent from bleeding than the others. Moreover, DEX can cause lower BP and HR in subjects with lower propofol administration, but the recovery time is longer. This study was registered by IRCT2017021114056N11 in Iranian Registry Clinical Center.
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Ondansetron 8 mg and 4 mg with normal saline against post-operative headache and nausea/vomiting after spinal anesthesia: a randomized double-blind trial p. 48
Shirin Pazoki, Hesameddin Modir, Alireza Kamali, Ashraf Zamani, Marzieh Shahidani
DOI:10.4103/2045-9912.235125  
The study aims to evaluate the efficacy of ondansetron in preventing post-spinal headache, considering the high prevalence of the headache in pregnant women and the common use of the adjuvants for prophylaxis against post-operative nausea and vomiting (PONV).This double-blind clinical trial included the 195 patients who were referred to Taleghani Hospital (in Arak, Iran) for cesarean section (C/S) under spinal anesthesia, and then the subjects were assigned to three equally sized groups using block randomization. Participants in the first, second, and control groups received 8 mg, 4 mg of ondansetron, and normal saline, respectively, 5 minutes before surgery. A final volume of 5 cc was prepared by adding normal saline. Participants were examined for headache one week after surgery, and then data analysis was performed using SPSS 20. The incidence of post-spinal headache was significantly higher in the placebo group than in the ondansetron 8-mg and 4-mg groups at 24 hours after surgery (P < 0.010). But, no significant difference was observed between two ondansetron groups (P ≤ 0.05). The overall incidence of the headache was generally lower in ondansetron 8-mg (26.66% vs. 33.68.05%) and 31.66% in ondansetron 4-mg (P < 0.001). Moreover, the PONV incidence was significantly higher in the placebo group than in the other two groups at 24 hours (P < 0.001). The hemodynamic variables were same in three groups. The ondansetron 8-mg dose can be effective to prevent headache after spinal anesthesia for C/S. Moreover, the ondansetron 8-mg and ondansetron 4-mg have same effect in control of PONV after spinal anesthesia for C/S.
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Safer employment of nitrous oxide in anesthesia machines—a technical simulation p. 54
Thomas Mitterlechner, Peter Paal, Daniel C Schroeder, Volker Wenzel, Holger Herff
DOI:10.4103/2045-9912.235127  
Several incidents of anesthesia-attributed mortality in the past were caused by misconnection of gas pipelines resulting in ventilation with pure nitrous oxide. A simple safety feature may be to “mark” nitrous oxide with a lower pressure than oxygen and room air within the hospital’s gas pipeline system. Then, any misconnection of gas pipelines could be detected by pressure differences with a manometer in the anesthesia machine. To check technical suitability, we tested maximum achievable nitrous oxide flows of an anesthesia machine at different pressures in the nitrous oxide supply line. Using decreased pressures for nitrous oxide compared to oxygen did not result in decreased nitrous oxide flows, as long as pressure in the nitrous oxide supply line was >1500 hPa. A concept of different pressures for nitrous oxide and oxygen could be used to technically differentiate between those two gases, and to avoid potentially fatal misconnections.
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Effects of hydrogen-occluding-silica microparticles on wound repair and cell migratory behavior of normal human esophageal epitheliocytes p. 57
Qiang Li, Yoshiharu Tanaka, Nobuhiko Miwa
DOI:10.4103/2045-9912.235128  
Many conventional studies on molecular hydrogen have not examined cell migration ability and the relationship between apoptosis and the cytoskeleton. Here we investigated the influence of hydrogen-occluding silica microparticles (H2-silica) on cell migration motility and changes of the cytoskeleton (F-actin) in normal human esophageal epithelial cells (HEEpiCs). As the results, cell migration was promoted, and formation of microvilli was activated in the 100 ppm (low concentration) scratched group. After performing a wound healing assay, cells exhibited migration after 48 hours and 72 hours for both 10 ppm and 100 ppm groups, suggesting that the wound-repairing effects could be attributed to the antioxidant ability of H2-silica. In scratched groups, high levels of activated caspase-3 were relatively expressed and presented a tendency to increase the observed Bax/Bcl-2 ratio at more than 300 ppm groups. The above-mentioned results show that H2-silica induced apoptosis in HEEpiCs, especially in the scratched cells. Toxicity may cause an exaggerated apoptosis. Furthermore, since the ratio of fascin/tubulin in the 100, 300, and 600 ppm groups tended to increase in both the scratched and the non-scratched control groups, H2-silica was thought to be able to promote fascin action on normal cells and may be have a proliferative effect.
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REVIEW Top

The role of argon in stroke p. 64
Xiang Li, Zhu-Wei Zhang, Zhong Wang, Jin-Quan Li, Gang Chen
DOI:10.4103/2045-9912.235129  
Stroke, also known as “cerebrovascular accident”, is an acute cerebrovascular disease that is caused by a sudden rupture of blood vessels in the brain or obstruction of the blood supply by blockage of blood vessels, thus including hemorrhagic and ischemic strokes. The incidence of ischemic stroke is higher than that of hemorrhagic stroke, and accounts for 80% of the total number of strokes. However, the mortality rate of hemorrhagic stroke is relatively high. Internal carotid artery and vertebral artery occlusion and stenosis can cause ischemic stroke, and especially males over 40 years of age are at a high risk of morbidity. According to the survey, stroke in urban and rural areas has become the first cause of death in China. It is also the leading cause of disability in Chinese adults. In a word, stroke is characterized by high morbidity, high mortality and high disability rates. Studies have shown that many noble gases have the neuroprotective effects. For example, xenon has been extensively studied in various animal models of neurological injury including stroke, hypoxic-ischemic encephalopathy. Compared to xenon, Argon, as a noble gas, is abundant, cheap and widely applicable, and has been also demonstrated to be neuroprotective in many research studies. In a variety of models, ranging from oxygen-glucose deprivation in cell culture to complex models of mid-cerebral artery occlusion, subarachnoid hemorrhage or retinal ischemia-reperfusion injury in animals. Argon administration after individual injury demonstrated favorable effects, particularly increased cell survival and even improved neuronal function. Therefore the neuroprotective effects of argon may be of possible clinical use for opening a potential therapeutic window in stroke. It is important to illuminate the mechanisms of argon in nerve function and to explore the best use of this gas in stroke treatment.
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CASE REPORT Top

Ozone therapy in conjunction with oral antibiotics as a successful primary and sole treatment for chronic septic prosthetic joint: review and case report Highly accessed article p. 67
Robert Jay Rowen
DOI:10.4103/2045-9912.235139  
The world is facing crisis in management of infectious diseases. The mainstay of treatment has been chemical anti-infectives. These drugs are failing, as superbugs emerge and medicine becomes more sophisticated with treatments such as prosthetic devices, which can harbor bacteria protected by biofilm. This case report describes a 68-year-old woman who received bilateral artificial hips on October 27, 2015. The right hip prosthesis subsequently became septic by June 2016. Three orthopedic surgeons offered her a several month program, which included removal of the prosthesis, implantation of an antibiotic impregnated “spacer” and months of intravenous antibiotics. Instead, she sought and received intravenous ozone therapy, local joint ozone gas injection, and nutritional supplements. She quickly improved. Subsequently, she was given oral Augmentin (875 mg three times daily) beginning at September 19, 2016 for 1 month, when a third culture returned positive for two oral organisms. She experienced even more rapid improvement. By October 12, she reported total resolution of symptoms. A subsequent MRI on November 30, 2016 showed total clearance of infection. This is the first report of a septic prosthetic joint infection completely resolving without some form of surgical intervention, debridement at the least. It is also the first to report such cure without the use of any parenteral antibiotics. This case and world literature suggest that ozone therapy could be considered as a useful adjunctive treatment for hard to treat infection and biofilm.
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LETTER TO THE EDITOR Top

Clinical utility of hyperbaric oxygen therapy in dentistry p. 72
Thorakkal Shamim
DOI:10.4103/2045-9912.235140  
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