Retrograde Lidocaine Spray for Awake Extubation in Pediatric ENT Surgery: Optimizing Tonsillectomy and Adenoidectomy Outcomes.

Laryngeal edema, a frequent manifestation of acute inflammation, is particularly significant due to the potential obstruction of the laryngeal orifice caused by swelling of the epiglottis and vocal cords. This presents as a risk factor that can lead to severe airway obstruction. Traditionally, deep extubation is the preferred form of extubation because it is more comfortable for the patient, eliminates the airway reflexes, and minimizes the risk of laryngeal edema. Difficult mask ventilation (DMV), characterized by an unassisted anesthesiologist's inability to maintain oxygen saturation levels above 92% or to prevent or correct signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia, necessitates an awake extubation approach. In the following case, combining the need to minimize airway reflexes through a deep extubation with the need for an awake intubation required an alternative method. Our patient is a 10-year-old male who presented with obstructive sleep apnea and tonsillar hypertrophy. The patient had a history of snoring and difficult intubation (three attempts), classifying him as a DMV risk. However, due to the difficult intubation, there was concern for laryngeal edema following the procedure that would necessitate a deep extubation. To effectively combine the two procedures, a retrograde lidocaine spray was used to numb the airway, which would allow for awake extubation without the associated coughing and bucking. Deep extubation is a common anesthetic technique used in laryngeal surgeries, but it is often not an option for high-risk patients. For such patients, awake extubation is an alternative. In our case, our patient was at high risk for laryngeal edema. In awake extubation, lidocaine spray is used for minimal coughing and bucking because it numbs the upper airway and allows the patient to tolerate the breathing tube without stimulating the gag reflex. The use of retrograde lidocaine spray for awake extubation in patients at high risk for laryngeal edema presents a promising alternative to traditional methods. This case demonstrates the effectiveness of retrograde lidocaine spray in awake extubation to reduce coughing and bucking by numbing the upper airway in a DMV situation while also avoiding complications in a high-risk patient.

The Impact of Social Support on Health Outcomes of Diabetic Patients: A Systematic Review.

Type 2 diabetes mellitus (T2DM) is a common chronic disease worldwide. The prevalence of T2DM has consistently increased over the past few decades. Factors affecting patient management of diabetes are important in preventing diabetic complications. Social support has been cited as one of the most important aspects of managing chronic conditions. This systematic review aims to consolidate the existing literature discussing the impact of social support on managing type 1 diabetes mellitus (T1DM) and T2DM. To begin our review, the Ovid MEDLINE (Medical Literature Analysis and Retrieval System Online) database was searched for all current literature on social support and diabetes health outcomes. Articles were then included and removed according to specific inclusion and exclusion criteria, and a systematic review was performed on the remaining articles. Twenty-two papers that met the inclusion and exclusion criteria were selected, and after data collection, a significant correlation was found between social support and health outcomes of diabetic patients and most articles reported that social support improves the health outcomes of diabetic patients. Studies show that there is some correlation between social support and improved health outcomes for diabetic patients. Further studies should be done to determine the exact correlations between social support and T2DM management and to explore the long-term impacts of social support on health outcomes for diabetic patients.

Evolution of LDL-C lowering medications and their cardiovascular benefits: Past, present, and future.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality worldwide. Hyperlipidemia, particularly elevated low-density lipoprotein cholesterol (LDL-C) is one of the major risk factors for CVD. Major landmark cardiovascular outcome clinical trials demonstrated that LDL-C lowering medications reduce cardiovascular events, and the lower the LDL-C the better the outcome. This article discusses the evolution of LDL-C lowering medications starting from bile acid sequestrants (BAS), statin therapy, bempedoic acid, the proprotein convertase subtilisin kexin 9 (PCSK9) synthesis inhibitor, novel small interfering RNA-based therapy (inclisiran) to the most recent oral PCSK9 inhibitors (MK-0616) which is currently under phase 3 clinical trial studies.

Analysis and comparison of genetic variants and mutations of the novel coronavirus SARS-CoV-2.

We present an analysis and comparison study of genetic variants and mutations of about 1200 genomes of SARS-CoV-2 virus sampled across the first seven months of 2020. The study includes 12 sets of about 100 genomes each collected between January and September. We analyzed the mutations, mutation frequency and count trends over time, and genomes trends over time from January through September. We show that certain mutations in the SARS-CoV-2 genome are not occurring randomly as it has been commonly believed. This finding is in agreement with other recently published research in this domain. Therefore, this validates other findings in this direction. This study includes approximately 1000 genomes and was able to identify over 35 different mutations most of which are common to almost all genomes groups. Some mutations' ratios (frequency percentage) fluctuate over time to adapt the virus to various environmental factors, climate, and populations. One of the interesting findings in this paper is that the coding region, at the nucleotide level for NSP13 protein is relatively conserved compared with other protein regions in the ORF1ab gene which makes this protein a good candidate for developing drug targets and treatment for the COVID-19 disease. Although this outcome was already reported by other researchers, we corroborated their result with our work in a different approach and another experimental setting with almost one thousand complete genome sequences. We presented and discussed all these results and findings with tables of results and illustrating figures.