A Survey of Paediatric Rapid Sequence Induction in a Department of Anaesthesia.

(1) Background: Rapid sequence induction (RSI) is carried out by anaesthetists to secure the airway promptly in patients who are at risk of aspirating gastric content during induction of anaesthesia. RSI requires variation in the paediatric population. We conducted a survey to investigate current practice of paediatric RSI by anaesthetists. (2) Methods: A descriptive, contextual, cross-sectional research design was followed. The study population consisted of all anaesthetists working in the Department of Anaesthesia at the University of the Witwatersrand. Data was collected in the form of a self-administered questionnaire. (3) Results: Of 138 questionnaires that were distributed, 126 were completed. Clinical indication for RSI was predominantly for appendicitis with peritonitis (115/124; 92.7%). Preoxygenation was performed by 95.1% of anaesthetists for children, 87% for infants and 89.4% for neonates. Cricoid pressure was used significantly more in children (56%) than in infants (20.8%) and neonates (10.3%) (p < 0.001). Rocuronium was the paralytic agent of choice in children (42.7%) and infants (38.2%), while cisatracurium was used most frequently in neonates (37.4%). Suxamethonium was used least in neonates. Cuffed ETTs were used most frequently for children (99.2%) and least for neonates (49.6%). Eighty-five percent of anaesthetists omitted cricoid pressure during RSI for pyloromyotomy, for which a controlled RSI was performed more by consultants and senior registrars (p < 0.01). A classic RSI was performed by 53.6% of anaesthetists for laparotomy for small bowel obstruction. Consultants and PMOs were more likely to intubate a child for forearm MUA who was starved for 6 h and received opioids (p < 0.05). Controlled RSI with cisatracurium was the technique of choice for Tenkhoff insertion in a child with renal failure. (4) Conclusions: RSI practice for paediatric patients varied widely among anaesthetists. This may be attributed to a combination of anaesthetic experience, training in paediatric anaesthesia, and patient specific factors, along with the individualised clinical scenario's aspiration risk. A controlled RSI technique appears to be implemented more frequently by anaesthetists with increased experience.

Luffa operculata at a late period of gestation dysregulates melatonin and cytokines interfering with weight of dams and their male offspring.

ETHNOPHARMACOLOGICAL RELEVANCE: The tea made with the fruits of Luffa operculata (L.) Cogn. (Cucurbitaceae; EBN) is popularly used as abortive. AIM OF THE STUDY: The present work aimed at accessing how the exposition of female Wistar rats to 1.0 mg/kg of EBN (experimental group, EG), or distilled water (control group, CG), by gavage, at gestational days (GD) 17-21 interfered with the reproductive performance, and with dams' behavior after weaning. MATERIALS AND METHODS: At post-natal day 2 (PND2), the number of male and female pups was evaluated, as well as their weight. After weaning (PND21), dams were euthanized, and their liver and kidneys were removed for histological and biochemical analyses, while the blood was used in the evaluation of cytokines IL-1α, IL-1ß, IL-6 and TNF-α, corticosterone, adrenocorticotrophic hormone, melatonin, AST, ALT and creatinine levels. RESULTS AND DISCUSSION: Dams that were treated with EBN showed an anxiety-like behavior, weight loss at the end of gestation and weight gain at weaning, accompanied with a significant decrease in pro-inflammatory cytokines and in the melatonin level. No significant histological or biochemical alterations have occurred in the liver or kidneys. The number of female pups was significantly higher in the EG. The male pups showed weight gain at PND60. CONCLUSION: The presence of cucurbitacins is probably involved in the dysregulations that were found, due to their polycyclic steroid triterpene structure.

Effects of Homeopathic Phosphorus on Encephalitozoon cuniculi-Infected Macrophages In-Vitro.

INTRODUCTION: Encephalitozoon cuniculi (E. cuniculi), a fungus that acts as an intracellular pathogen, causes a marked neurological syndrome in many host species and is a zoonotic concern. Although no well-established treatment for this syndrome is known, previous successful clinical experience using homeopathic phosphorus has been described in which symptom remission with no mortality occurred in 40/42 animals by means of unknown immunological mechanisms. The latter observation was the main motivation for this study. OBJECTIVE: To verify, in an in-vitro model, if macrophages infected with E. cuniculi can change in function after treatment with different potencies of phosphorus. MATERIALS AND METHODS: RAW 264.7 macrophages were infected with E. cuniculi in-vitro and treated with various homeopathic potencies of phosphorus. The vehicle was used as a control solution (0.06% succussed ethanol). After 1 and 24 hours, the following parameters were analyzed: parasite internalization (by the Calcofluor staining method), lysosome activity (by the acridine orange method), cytokine/chemokine production (by the MAGPIX system), and cell ultrastructure. Automatic image analysis was used when applicable, and the experiments were performed in triplicate. RESULTS: Treatment with vehicle alone increased interleukin (IL)-6, tumor necrosis factor alpha and monocyte chemotactic protein -1 production (p ≤ 0.05) and reduced the number of internalized parasites (p ≤ 0.001). A progressive and time-dependent increase in RANTES (regulated on activation, normal T-cell expressed and secreted) and lysosome activity (p ≤ 0.002) was observed only after treatment with the highest potency of phosphorus (Phos 200cH), together with decreased apoptosis rate, intense parasite digestion, and the presence of non-internalized spores. CONCLUSIONS: Phos 200 cH has a modulatory action on the activity of infected macrophages, especially a specific increase in RANTES, a key element in the prognosis of E. cuniculi-infected and of immunosuppressed patients bearing infections.

Biological Actions, Electrical Conductance and Silicon-Containing Microparticles of Arsenicum Album Prepared in Plastic and Glass Vials.

INTRODUCTION: According to the "silica hypothesis" formulated to explain homeopathy, the information of starting materials would be transferred to cells by silica nanoparticles detached from the glassware walls by serial dilution and agitation through epitaxy. We compared the biological activity, electrical current and silicon microparticle content (by means of scanning electron microscopy/energy-dispersive X-ray spectroscopy) of high dilutions (HDs) of arsenic prepared in plastic and glass vials to investigate the role of silica in their biological effects in vitro. MATERIALS AND METHODS: Co-cultures of macrophages and yeast (Saccharomyces cerevisiae) were treated with different HDs of arsenic prepared in plastic and glass vials. Macrophage morphology, phagocytosis index, nitric oxide (NO), and cytokine production were evaluated. RESULTS: Measurable amounts of silicon microparticles were detected only in the HDs prepared in glass vials, but ultra-centrifugation eliminated them. Specific and non-specific results were observed. Non-specific pro-inflammatory effects were seen in all dilutions prepared in plastic vials, including elevation of pro-inflammatory cytokines, NO and macrophage phagocytic index. Only the 200th centesimal dilution of arsenic produced specific decrease in interleukin-6 production in macrophages, and it was independent of the vial type or the presence of microparticles of silica in the medicine samples. The nature of the vials had an impact on the electric flow in the respective fluids. CONCLUSION: The non-specific, pro-inflammatory effects might be attributed to organic residuals detached from the vials' plastic walls during manipulation. Instead, specific silica-independent effects of the homeopathic medicine can be attributed to the decrease of interleukin-6 after treatment with the 200th centesimal dilution of arsenic.

Homeopathic medicine Cantharis modulates uropathogenic E. coli (UPEC)-induced cystitis in susceptible mice.

OBJECTIVE: This is a random blinded placebo controlled murine experimental model to study the effects of Cantharis 6 CH, a homeopathic medicine, on E coli-induced cystitis. METHODS: 24 adult susceptible female BALB/c mice were inoculated with E coli - UPEC O4:K-:H5 by a transurethral catheter. Cantharis 6cH or vehicle (placebo) was offered to mice by free access into the drinking water (1:100), during 24 h after infection. Spleen, bladder and kidneys were processed for quantitative histopathology after immunohistochemistry, using anti-CD3, CD79, MIF, NK and VEGF antibodies; the cytokines present in the bladder washing fluid were measured using a LUMINEX-Magpix KIT. Mann-Whitney and Fisher exact test were used as statistical analysis. RESULTS: Cantharis 6 CH increased IL12p40, IFN-γ and decreased IL10 concentrations in the bladder fluid (p⩽0.05); in the bladder mucosa, it increased the ratio between B and T lymphocytes (31%) and between B lymphocytes and MIF+ macrophages (57%, p⩽0.05). In the pelvis, instead, it decreased the B/T cells ratio (41%, p⩽0.05) and increased the M1/M2 macrophage ratio (42%, p⩽0.05). No differences were seen in the kidney and spleen analysis. CONCLUSION: The inverted balance of inflammatory cells and cytokines in bladder and pelvis mucosa shows specific local immune modulation induced by Cantharis 6cH.

High dilutions of antimony modulate cytokines production and macrophage - Leishmania (L.) amazonensis interaction in vitro.

BACKGROUND: In previous results mice treated with high dilutions of antimony presented reduction of monocyte migration to the site of infection with increase in B lymphocytes population in the local lymph node. AIMS: To know the mechanisms involved, a series of in vitro studies was done, using co-cultures of macrophages (RAW 264.7) and Leishmania (L.) amazonensis treated with different dilutions of antimony (Antimonium crudum or AC), in different times. METHODOLOGY: Spreading, phagocytosis, the oxidative activity of macrophages, the viability of free promastigotes and the cytokines/chemokines concentration in the supernatant were evaluated. The assays were performed in quadruplicate. RESULTS: Cells treated with AC 30cH (10-58M) and AC 200cH (10-398M) presented a temporary reduction of the spreading after 02h of incubation, followed by increase after 48h, being the most significant increase observed after the AC 200cH treatment. However, the percentage of internalized parasites at 48, 96 and 120h of incubation was also higher in cells treated with AC 200cH. It is suggested that the AC 200cH improves the ability of phagocytes to internalize the parasites, but not to digest them. The cytokines-chemokines panel corroborated these results. Both dilutions potentiated the parasite-induced reduction of cytokines production, especially IL-6, IL 12 p40 and γ-IFN, after 48h of incubation. In addition, the production of MIP-1 beta (CCL4), a chemokine involved in chronic inflammation, was also reduced after 120h. A specific effect of AC 30cH was seen by the inhibition of two peaks of CCL2 (MCP-1) observed in infected macrophages, at 24 and 120h. Since this cytokine is an important chemokine for monocytes, it explains the results obtained formerly in vivo. The morphology of macrophages after acridine orange staining revealed that the treatment with AC 30cH reduced substantially the acid vacuoles in the cytoplasm, indicating a certain inability of these cells to digest the parasites. On the other hand, a large peak of VEGF-A, associated with increase of internalized parasites was observed after 120h of treatment with AC 200cH, which could be associated to the regulation of the chronic inflammation events by M1-M2 polarization. There was no statistical difference among groups regarding the production of TNF, NO and H2O2, showing that the drugs do not alter macrophage cytotoxic activity. A clear quantitative and qualitative variation of the modulatory effects of AC 30cH and 200cH was seen, in function of time. CONCLUSIONS: Both dilutions were able to potentiate the decrease of most of cytokines and chemokines induced by the parasite infection in vitro, which explains the clinical improvement seen previously in vivo, however, the mechanisms involved and the epidemiological significance of these findings are still under discussion.

Efeitos da exposição de ratos adultos ao lipopolissacarídeo (LPS) no comportamento estereotipado e na catatonia experimental / Effects of lipopolysaccharide (LPS) administration on stereotypy and catatonia of male adult mice

Introdução - O lipopolissacarídeo (LPS), um componente da parede celular de bactérias gram-negativas age como um pirógeno exógeno, induzindo os macrófagos a liberar citocinas como o Fator de Necrose Tumoral (TNF), e Interleucinas 1, 6 e 8, entre outras. Dentre as ações das citocinas que alteram diferentes funções do organismo e são mediadas pelo SNC citam-se a febre, as alterações neuroendócrinas, alterações no sono e outras alterações comportamentais (atividades exploratórias, sexuais e sociais). Ainda não há um entendimento definitivo de como os processos sistêmicos ativam o SNC. Algumas evidências indicam que o LPS produz lesão em sistemas dopaminérgicos centrais, envolvendo processos inflamatórios como a etiologia da doença de Parkinson. Desde que esta resulta de lesões em sistemas dopaminérgicos nigroestriatais,o presente trabalho investigou os efeitos da administração aguda de LPS em comportamentos ligados ao sistema dopaminérgico central, a estereotipia e a catatonia induzidas por anfetamina e haloperidol, respectivamente, agonistas e antagonistas dopaminérgicos centrais. Material e Métodos - Camundongos receberam 100 ug/kg de LPS e foram observados em campo aberto. O comportamento estereotipado induzido por 2 mg/kg de anfetamina e a catatonia induzida pelo haloperidol (4 mg/kg) foram observadas em animais tratados ou não com LPS. Resultados - O LPS reduziu a atividade geral dos animais em campo aberto e no comportamento estereotipado induzido pela anfetamina. Por outro lado, observou-se persistência na catatonia induzida pelo haloperidol, resultando em maior intensidade do mesmo. Conclusões - Estes dados permitiram sugerir que o processo inflamatório induzido pelo lipopolissacarídeo interfere com sistemas dopaminérgicos nigroestriais, porém estes resultados necessitam ser investigados em estudos mais aprofundados.

Introduction - The lipopolysaccharide (LPS), is a component of the cell wall of gram-negative bacteria acting as an exogenous pirogen by release from macrophage cytokines as Tumor Necrosis Factor (TNF), and Interleucinas 1, 6 and 8.among others. Cytokines affect different functions of the body and that are mediated by SNC is fever, neuroendocrine changes, interference in sleep and other behavioral changes (exploratory activity, sexual and social). Some evidence indicates that the LPS produces damage in central dopaminergic systems, involving inflammatory processes such as the etiology of Parkinson's disease. Since this is the result of injuries in dopaminergic nigroestriatal system, this work investigated the effects of acute administration of LPS in behaviors related to the central dopaminergic system, the stereotypy and catatonia induced by haloperidol and amphetamine, respectively, central dopaminergic agonists and antagonists. Material and Methods - Rats received 100 ug/kg LPS and were observed in an open to determine the time-curve effect. The stereotyped behavior induced by 2 mg/kg of amphetamine and catatonia induced by haloperidol (4 mg / kg) were observed in animals treated with LPS or not. Results - LPS reduced the overall activity of the animals in the open and the stereotypy induced by amphetamine significantly. Furthermore, there was persistent in catatonia induced by haloperidol, resulting in greater intensity of it. Conclusions - These data suggest that the inflammatory process induced by LPS interferes with nigroestriaL dopaminergic systems.