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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 9 | Issue 2
Page Nos. 55-109

Online since Tuesday, June 25, 2019

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RESEARCH ARTICLES  

Effect of different doses of intrathecal dexmedetomidine on hemodynamic parameters and block characteristics after ropivacaine spinal anesthesia in lower-limb orthopedic surgery: a randomized clinical trial p. 55
Laleh Farokhmehr, Hesameddin Modir, Bijan Yazdi, Alireza Kamali, Amir Almasi-Hashiani
DOI:10.4103/2045-9912.260645  PMID:31249252
The study aims to compare the efficacy of different doses of intrathecal dexmedetomidine on hemodynamic parameters and block characteristics after ropivacaine spinal anesthesia in lower-limb orthopedic surgery. In a double-blind trial, 90 patients undergoing spinal anesthesia for lower-limb orthopedic surgery were included and then randomly assigned to three groups; dexmedetomidine 5 μg/kg, dexmedetomidine 10 μg/kg and placebo. Blood pressure, heart rate, and oxygen saturation were recorded in the three groups at the first 15 minutes and then every 15 to 180 minutes at recovery by a resident anesthesiologist, as well as sensory-motor block onset. The visual analog scale scores for the assessment of pain were recorded at recovery, and 2, 4, 6, and 12 hours postoperatively and the data were analyzed by Stata software. The onset and time to achieve sensory block to ≥ T8 were faster in the 10 μg/kg dexmedetomidine group than the other groups (P = 0.001). The Bromage score was higher in the 10 μg/kg dexmedetomidine group (P = 0.0001) with lower pain score as compared with the 5 μg/kg dexmedetomidine and placebo groups (P = 0.0001). Therefore, an increase in dexmedetomidine hastens the onset of sensory-motor block but not causes side effects. This study was approved by the Ethical Committee of Arak University of Medical Sciences in 2017 (Ethical Code: IR.ARAKMU.REC.1396.37), and the trail was registered and approved by the Iranian Registry of Clinical Trials in 2017 (IRCT No. IRCT2017070614056N12).
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Premedication effect of melatonin on propofol induction dose for anesthesia, anxiety, orientation and sedation after abdominal surgery: a double-blinded randomized trial p. 62
Afsaneh Norouzi, Shahin Fateh, Hesameddin Modir, Alireza Kamali, Leila Akrami
DOI:10.4103/2045-9912.260646  PMID:31249253
The present study addressed the effect of melatonin premedication on propofol induction dose for anesthesia in abdominal surgery. This is a double-blinded clinical trial in which abdominal surgery patients admitted to the Valiasr Hospital, Iran (n = 88) were enrolled and individually randomized into two groups: melatonin and placebo groups sublingually administered 3 mg of melatonin and placebo, respectively, 50 minutes before surgery. Their anxiety, orientation, and sedation were recorded before melatonin administration, anesthesia induction, and recovery, while we also recorded the propofol induction dose required for general anesthesia. Anxiety was seen less in the melatonin group than the placebo group (P < 0.05), whereas orientation was significantly different before anesthesia induction (P = 0.044) and sedation was the same before the induction (P = 0.044) and recovery (P = 0.049) in both groups, with a better efficiency in the melatonin group in which a lower dose of propofol was used (P = 0.002). The sedation, anxiety, and propofol dose used were lower in the melatonin group than the placebo group. The recommended dosage was 3 mg of melatonin once to achieve an anesthetic depth index or a bispectral index of 40. The study was approved by Ethical Committee of Arak University of Medical Sciences with IR.ARAKMU.REC.1395.432 code in July 2016, and the trial was registered in Iranian Registry of Clinical Trials with IRCT20141209020258N98 in September 2016.
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Effects of hydrogen-rich water bath on visceral fat and skin blotch, with boiling-resistant hydrogen bubbles p. 68
Ryoko Asada, Yasukazu Saitoh, Nobuhiko Miwa
DOI:10.4103/2045-9912.260647  PMID:31249254
Hydrogen-dissolved water has been shown to improve diverse oxidation stress-related diseases, which drove us to examine effects of hydrogen-rich water on oxidation stress-related skin troubles and lipid-metabolism markers. The purpose of this study is whether the dissolved hydrogen in hydrogen-rich water was kept even after boiling, and whether hydrogen-bath utilization improves cosmetic effects such as skin-blotch repression and the visceral-fat-based slimming effects. The subjects were two men and two women, aged 48, 43, 42, and 41 years (n = 4). They took warm (41°C) water bath of dissolved hydrogen 300–310 μg/L (< 10 μg/L for normal water) for 10-minute once daily for 1–6 months, followed by examination of skin blotch, visceral fat, and cholesterol and glucose metabolisms. The dissolved hydrogen concentration was measured after 15-minute boiling and the subsequent cooling naturally. The wide-ranging, dense, and irregularly shaped skin blotches became markedly smaller and thinner, assumedly through reductive bleaching of melanin and lipofuscin and promotion of dermal cell renewal by the hydrogen-rich warm water. Ultrasonic resonance-based analysis on the abdominal cross-section revealed that the visceral fat area decreased from 47 to 36 cm[2], and the abdominal circumference decreased from 91 to 82 cm, in the two female subjects bathing in hydrogen-water. After 6-month hydrogen-water bathing, the low-density lipoprotein cholesterol level was decreased by 16.2% and the fasting blood glucose level increased by 13.6% in the blood of a female subject. Before boiling, the dissolved hydrogen and an oxidation-reduced potential were 300 μg/L and –115 mV, respectively. Dissolved hydrogen was retained at 300–175 μg/L and 200 μg/L, even 1–6 hours and 24 hours, respectively, after boiling. Therefore, a hydrogen-rich water-bath apparatus can electrolytically generate abundant boiling-resistant hydrogen bubbles, improving visceral fat and blotches on the skin. The study was approved by the Medical Ethics Committee of the Japanese Center for Anti-Aging Medical Sciences and that was officially authenticated by the Hiroshima Prefecture Government of Japan (approval number 15C1) in 2016.
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Hydrogen gas therapy improves survival rate and neurological deficits in subarachnoid hemorrhage rats: a pilot study p. 74
Richard Camara, Nathanael Matei, Justin Camara, Budbazar Enkhjargal, Jiping Tang, John H Zhang
DOI:10.4103/2045-9912.260648  PMID:31249255
The high morbidity, high mortality, and significant shortage of effective therapies for subarachnoid hemorrhage (SAH) have created an urgency to discover novel therapies. Human studies in Asia have established the safety of hydrogen gas in the treatment of hepatic, renal, pulmonary, and cardiac diseases. Mechanistically, hydrogen gas has been shown to affect oxidative stress, inflammation, and apoptosis. We hypothesized that hydrogen therapy would improve neurological function and increase survival rate in SAH. High dose hydrogen gas (66% at 3 L/min) was administered for 2 hours at 0.5, 8, and 18 hours after SAH. This treatment increased 72-hour survival rate and provided 24-hour neuroprotection after SAH in rats. To our knowledge, this is the first report demonstrating that high dose hydrogen gas therapy reduces mortality and improves outcome after SAH. Our results correlate well with the proposed mechanisms of hydrogen gas therapy within the literature. We outline four pathways and downstream targets of hydrogen gas potentially responsible for our results. A potentially complex network of pathways responsible for the efficacy of hydrogen gas therapy, along with a limited mechanistic understanding of these pathways, justifies further investigation to provide a basis for clinical trials and the advancement of hydrogen gas therapy in humans. This study was approved by the Institutional Animal Care and Use Committee of Loma Linda University, USA (Approval No. 8160016) in May 2016.
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REVIEWS Top

Recent advances in the neuroprotective effects of medical gases p. 80
Yue-Zhen Wang, Ting-Ting Li, Hong-Ling Cao, Wan-Chao Yang
DOI:10.4103/2045-9912.260649  PMID:31249256
Central nervous system injuries are a leading cause of death and disability worldwide. Although the exact pathophysiological mechanisms of various brain injuries vary, central nervous system injuries often result in an inflammatory response, and subsequently lead to brain damage. This suggests that neuroprotection may be necessany in the treatment of multiple disease models. The use of medical gases as neuroprotective agents has gained great attention in the medical field. Medical gases include common gases, such as oxygen, hydrogen and carbon dioxide; hydrogen sulphide and nitric oxide that have been considered toxic; volatile anesthetic gases, such as isoflurane and sevoflurane; and inert gases like helium, argon, and xenon. The neuroprotection from these medical gases has been investigated in experimental animal models of various types of brain injuries, such as traumatic brain injury, stroke, subarachnoid hemorrhage, cerebral ischemic/reperfusion injury, and neurodegenerative diseases. Nevertheless, the transition into the clinical practice is still lagging. This delay could be attributed to the contradictory paradigms and the conflicting results that have been obtained from experimental models, as well as the presence of inconsistent reports regarding their safety. In this review, we summarize the potential mechanisms underlying the neuroprotective effects of medical gases and discuss possible candidates that could improve the outcomes of brain injury.
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The role of hydrogen sulfide in gastric mucosal damage p. 88
Fang Shen, Chong-Shun Zhao, Mei-Fen Shen, Zhong Wang, Gang Chen
DOI:10.4103/2045-9912.260650  PMID:31249257
Gastrointestinal disease is a major global threat to public health. In the past few decades, numerous studies have focuses on the application of small molecule gases in the disease treatment. Increasing evidence has shown that hydrogen sulfide (H2S) has anti-inflammatory and anti-oxidative effects, and can regulate gastric mucosal blood flow in the gastric mucosa. After gastric mucosa damage, the level of H2S in the stomach decreases. Administration of H2S can protect and repair the damaged gastric mucosa. Therefore, H2S is a new target for the repair and treatment of gastric mucosa damage. In this review, we introduce the roles of H2S in the treatment of gastric mucosa damage and provide the potential strategies for further clinical treatment.
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Clinical utility of hyperbaric oxygen therapy in dentistry p. 93
Kaitlyn Re, Shrey Patel, Jason Gandhi, Yiji Suh, Inefta Reid, Gunjan Joshi, Noel L Smith, Sardar Ali Khan
DOI:10.4103/2045-9912.260651  PMID:31249258
This fuller impact of the use of hyperbaric oxygen therapy within dentistry is taking greater notice with newer research findings. There are new advancements in research regarding postradiotherapy cases, osteonecrosis of the jaw, osteomyelitis, periodontal disease, and dental implants. Hyperbaric oxygen therapy can even be used in conjunction with other procedures such as bone grafting. Although the research and clinical utility has come a long way, there are several complications to be mindful of during the application of hyperbaric oxygen therapy.
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Ozone therapy: a potential therapeutic adjunct for improving female reproductive health p. 101
Zaher Merhi, Bhavika Garg, Rajean Moseley-LaRue, Amber Ray Moseley, André Hugo Smith, John Zhang
DOI:10.4103/2045-9912.260652  PMID:31249259
Ozone is emerging as a new adjunct therapeutic agent for female infertility. We here present a review of the literature, to date, pertaining to the effect of ozone therapy on tubal, ovarian, endometrial, and vaginal factors that could potentially affect female fertility. It also presents data pertaining to the relationship of ozone therapy on pelvic adhesion formation. Most data were performed on animals and very few human studies existed in the literature. Results suggested that ozone therapy could have beneficial effect on tubal occlusion, could protect from endometritis and vaginitis, might protect ovaries from ischemia and oocyte loss and finally might lead to less formation of pelvic adhesions. There is a critical need for human studies pertaining to ozone therapy, especially using safe methods of administration, such as transdermally or intravaginally, on female fertility.
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LETTERS TO THE EDITOR Top

Pediatric dental sedation p. 106
Thorakkal Shamim
DOI:10.4103/2045-9912.260653  PMID:31249260
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Minimum alveolar concentration based anesthesia in high altitude and anesthetic overdose: result needs cautious acceptance p. 107
Habib Md Reazaul Karim
DOI:10.4103/2045-9912.260654  PMID:31249261
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MEETING UPDATE Top

2019 International hydrogen molecular medicine summit p. 108
Ling-Ting Zeng, Feng Zhou, Goshi Ekta, Ying-Shuai Wang
DOI:10.4103/2045-9912.260655  PMID:31249262
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