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   Table of Contents - Current issue
January-March 2019
Volume 9 | Issue 1
Page Nos. 1-54

Online since Thursday, March 28, 2019

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The National Brain Injury Rescue and Rehabilitation Study - a multicenter observational study of hyperbaric oxygen for mild traumatic brain injury with post-concussive symptoms Highly accessed article p. 1
B Robert Mozayeni, William Duncan, Eddie Zant, Tommy L Love, Robert L Beckman, Kenneth P Stoller
DOI:10.4103/2045-9912.254636  PMID:30950414
The National Brain Injury Rescue and Rehabilitation Project was established as a preliminary study to test the safety and practicality of multi-center hyperbaric oxygen administration for the post-concussive symptoms of chronic mild traumatic brain injury as a precursor to a pivotal, independent, multi-center, controlled clinical trial. This report presents the results for 32 subjects who completed a preliminary trial of hyperbaric oxygen several years before the passage of the 21 st Century Cures Act. This study anticipated the Act and its reassessment of clinical research. Subjects received 40-82 one-hour treatments at 1.5 atmospheres absolute 100% oxygen. Outcome measures included repeated self-assessment measures and automated neurocognitive tests. The subjects demonstrated improvement in 21 of 25 neurocognitive test measures observed. The objective neurocognitive test components showed improvement in 13 of 17 measures. Earlier administration of hyperbaric oxygen post injury, younger age at the time of injury and hyperbaric oxygen administration, military status, and increased number of hyperbaric oxygen administrations were characteristics associated with improved outcomes. There were no adverse events. Hyperbaric oxygen was found to be safe, inexpensive and worthy of clinical application in the 21 st Century model of facile data collection provided by recent research regulatory shifts in medicine. The study was approved by the ethics review committee of the Western Institutional Review Board (WIRB; Protocol #20090761).
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An observation from an online survey: is fresh gas flow used for sevoflurane and desflurane different from isoflurane based anesthesia? p. 13
Habib Md Reazaul Karim, Mamta Sinha, Mayank Kumar, Monica Khetrapal, Rashmi Dubey
DOI:10.4103/2045-9912.254637  PMID:30950415
Minimal uses of fresh gas flow (FGF) during volatile inhalational agents based anesthesia are gaining popularity for many reasons. However, the practice pattern is not uniform. Even the same anesthesiologist uses different FGF for different agents. The present study was aimed to evaluate the variation in the practice pattern of FGF used in context to volatile agents used. With departmental approval, the present study was conducted by reviewing the data of a previously conducted cross-sectional survey. The survey was conducted from January 2018 to May 2018 using SurveyMonkey; . Anesthesiologists working in different organizations across India were approached through e-mail and WhatsApp and anonymous responses were collected. The responses which contained FGF data for isoflurane and for at least one of either sevoflurane and/or desflurane were included. A total of 236 eligible responses were analyzed. The FGFs used by different anesthesiologists were very much inconsistent; only 5.1% used FGF < 600 mL/min and 19.1% used 600-1000 mL/min consistently for all three agents. There was a significant variation of FGF used for sevoflurane and desflurane as compared to isoflurane. Use of FGF of < 1000 mL/min was significantly higher for the desflurane as compared to both isoflurane and sevoflurane. The uses of lower FGF greatly vary both at intrapersonal as well as interpersonal level. The possibility of using FGF < 1000 mL/min is significantly higher with desflurane as compared to isoflurane. Volatile anesthetic agent appears to be a factor for the decision making on the use of low flow anesthesia.
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Ultrasonography for oxygen-ozone therapy in musculoskeletal diseases p. 18
Eleonora Latini, Enrico Roberto Curci, Andrea Massimiani, Sveva Maria Nusca, Flavia Santoboni, Donatella Trischitta, Mario Vetrano, Maria Chiara Vulpiani
DOI:10.4103/2045-9912.254638  PMID:30950416
Over the years, infiltrative oxygen-ozone therapy has shown clinical benefits in several musculoskeletal disorders, due to its potential analgesic, anti-inflammatory, antioxidant and immunomodulatory effect. Ultrasonography is a safe, non-invasive imaging, easily available, and has the additional advantage of being real time for imaging and image-guided procedures of the musculoskeletal system. This review explains the numerous promising ways in which ultrasonography can be useful in oxygen-ozone therapeutic practices for musculoskeletal disorders, in order to improve safety and accuracy of treatment.
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Neurointegrity and neurophysiology: astrocyte, glutamate, and carbon monoxide interactions p. 24
Vicki L Mahan
DOI:10.4103/2045-9912.254639  PMID:30950417
Astrocyte contributions to brain function and prevention of neuropathologies are as extensive as that of neurons. Astroglial regulation of glutamate, a primary neurotransmitter, is through uptake, release through vesicular and non-vesicular pathways, and catabolism to intermediates. Homeostasis by astrocytes is considered to be of primary importance in determining normal central nervous system health and central nervous system physiology - glutamate is central to dynamic physiologic changes and central nervous system stability. Gasotransmitters may affect diverse glutamate interactions positively or negatively. The effect of carbon monoxide, an intrinsic central nervous system gasotransmitter, in the complex astrocyte homeostasis of glutamate may offer insights to normal brain development, protection, and its use as a neuromodulator and neurotherapeutic. In this article, we will review the effects of carbon monoxide on astrocyte homeostasis of glutamate.
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Developing a standardized system of exposure and intervention endpoints for isoflurane in preclinical stroke models p. 46
Tyler C Hillman, Nathanael Matei, Jiping Tang, John H Zhang
DOI:10.4103/2045-9912.254640  PMID:30950418
Isoflurane is a regularly used anesthetic in translational research. Isoflurane facilitates invasive surgery and a rapid recovery. Specifically, in the pathology of stroke, controversy has surrounded isoflurane's intrinsic neuroprotective abilities, affecting apoptosis, excitotoxicity, and blood brain barrier disruption. Due to the intrinsic neuroprotective nature and lack of standardized guidelines for the use of isoflurane, research has shifted away from this gas in most animal models. Antagonistically, studies have also reported that no neuroprotective effects are observed when a surgery is accompanied with isoflurane exposure under 20 minutes. Isoflurane affects the pathophysiology in stroke patients by altering critical pathways in endothelial, neuronal, and microglial cells. Current studies have elucidated isoflurane neuroprotection to be time dependent and may be minimized in experimental designs if the exposure time is limited to a specific window. Therefore, with detailed and extensive literature on anesthetics, we can hypothesize that isoflurane exposure under the 20-minute benchmark, behavior and molecular pathways can be evaluated at any time-point following ischemic insult without confounding artifacts from isoflurane; however, If the exposure to isoflurane exceeds 20 minutes, the acute neuroprotective effects are evident for 2 weeks in the model, which should be accounted for in molecular and behavioral assessments, with either isoflurane inhibitors or a control group at 2 weeks post middle cerebral artery occlusion. The purpose of this review is to suggest a detailed and standardized outline for interventions and behavioral assessments after the use of isoflurane in experimental designs.
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Pharmacogenomics of inhalational anesthetic agents p. 52
Abhijit S Nair
DOI:10.4103/2045-9912.254641  PMID:30950419
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Cryogens in dentistry p. 54
Thorakkal Shamim
DOI:10.4103/2045-9912.254642  PMID:30950420
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Retraction: A survey of anaphylaxis etiology and treatment p. 54
DOI:10.4103/2045-9912.254643  PMID:30950421
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