Neoteric Biofilms Applied to Enhance the Safety Characteristics of Ras Cheese during Ripening.

The milk's natural flora, or the starter, can preserve cheesemaking and allow for microbial competition. This investigation aimed to improve cheese safety and assess its characteristics using probiotic cell pellets (LCP) or cell-free extracts (CFS). Cheese samples were collected from different areas to investigate the current contamination situation. Six CFSs of probiotics were assessed as antifungal against toxigenic fungi using liquid and solid media and their aflatoxin reduction impact. The most effective CFS was chosen for cheese coating in nanoemulsion. Coated cheese with CFS, LCP, and LCP-CFS was assessed against control for changes in chemical composition, ripening indications, rheological properties, and microbiology. Results showed significant contamination levels in the collected samples, and toxic fungi were present. Lactobacillus rhamnosus CFS has aflatoxins reducibility in liquid media. During cheese ripening, uncoated cheese showed higher fat, protein, salt content, soluble nitrogen, total volatile fatty acids, tyrosine, and tryptophan contents than coated samples, except for LCP-coating treatment. Cheese rheology indicated that coating treatments had the lowest hardness, cohesiveness, gumminess, chewiness, and springiness compared to uncoated cheese. Uncoated cheese had the highest yeast and mold counts compared to the treated ones. The LCP-CFS-coated cheese showed no Aspergillus cells for up to 40 days. Uncoated Ras cheese recorded slightly lower flavor, body, texture, and appearance scores than coated cheeses. In conclusion, coating cheese with L. rhamnosus nanoemulsion has antifungal and antiaflatoxigenic properties, even for LCP, CFS, and CFS-LCP, which could extend cheese shelf life.

Spergularia marina: a potential source of a novel calcium channel blocker with antihypertensive and diuretic activities.

OBJECTIVE: Spergularia marina (L.) Griseb. (S. marina) is a sub-cosmopolitan species used as traditional phytotherapy based on diverse biological activities. It is native and widespread in the northern hemisphere, though introduced also into the southern hemisphere. The extract of another species 'Spergularia purpurea' has been traditionally used in Morocco against various diseases and S. marina, itself, is a local popular food in South Korea. In this context, we evaluated the potential antihypertensive and diuretic effects of S. marina water and n-butanol extracts in L-NAME-induced hypertensive rats vs. the well-known diuretic, furosemide. MATERIALS AND METHODS: After toxicity studies, selected doses were administered orally daily for one week. Mean arterial blood pressure (MABP), water/electrolyte clearance, renal functions, and serum electrolytes were assessed. Vascular reactivity of isolated aortic rings was evaluated under different incubating settings against various antagonists to unravel the mechanism of action. RESULTS: Both extracts significantly reduced the MABP. Only, the n-butanol fraction exerted a significant aquaresis, increasing electrolyte free-water clearance with a significantly decreased urinary Na+, K+, and C- excretion. The water extract significantly augmented the ACh-induced relaxation and attenuated the NE-induced aortic rings' contractile response. It also exhibited a direct relaxant effect on the NE-precontracted rings with intact or denuded endothelium. Blocking the vascular calcium channels by preincubation with nifedipine prevented the S. marina-induced relaxation, denoting a calcium channel blocking activity. CONCLUSIONS: The vasorelaxant and the differential diuretic effects of both extracts introduce S. marina as a potential novel antihypertensive agent with calcium channel blocking activity. To enrich cardiovascular therapeutics, human studies to confirm the efficacy and safety of S. marina in hypertension are warranted. GRAPHICAL ABSTRACT: https://www.europeanreview.org/wp/wp-content/uploads/Graphical-abstract.jpg.

Effect of suxamethonium vs rocuronium on onset of oxygen desaturation during apnoea following rapid sequence induction.

This study investigates the effect of suxamethonium vs rocuronium on the onset of haemoglobin desaturation during apnoea, following rapid sequence induction of anaesthesia. Sixty patients were randomly allocated to one of three groups. Anaesthesia was induced with lidocaine 1.5 mg.kg(-1), fentanyl 2 microg.kg(-1) and propofol 2 mg.kg(-1), followed by either rocuronium 1 mg.kg(-1) (Group R) or suxamethonium 1.5 mg.kg(-1) (Group S). The third group received propofol 2 mg.kg(-1) and suxamethonium 1.5 mg.kg(-1) only (Group SO). The median (IQR [range]) time to reach S(p)O(2) of 95% was significantly shorter in Group S (358 (311-373 [245-430]) s) [corrected] than in Group R (378 (370-393 [366-420]) s; p = 0.003), and shorter in Group SO (242 (225-258 [189-270]) s) [corrected] than in both Group R (p < 0.001) and Group S (p < 0.001). When suxamethonium is administered for rapid sequence induction of anaesthesia, a faster onset of oxygen desaturation is observed during the subsequent apnoea compared with rocuronium. However, time to desaturation is prolonged whenever lidocaine and fentanyl precede suxamethonium.

Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature.

The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.

Comparison of three doses of epidural fentanyl followed by bupivacaine and fentanyl for labor analgesia.

BACKGROUND: Epidural fentanyl 100 microg after lidocaine-epinephrine test dose has been shown to provide adequate analgesia in early labor. This investigation determines the effect of three different bolus doses of epidural fentanyl on duration and quality of analgesia during early first stage of labor. METHODS: In this prospective, double-blind study, 103 laboring nulliparous at cervical dilation <5 cm were enrolled. After an epidural test dose of lidocaine (60 mg) with epinephrine (15 microg), parturients received, randomly, bolus of epidural fentanyl 50, 75, or 100 microg, followed by a continuous infusion of epidural bupivacaine 0.0625% and fentanyl 3 microg/ml at a rate of 10 ml/h. Pain scores and maternal sedation, pruritus, nausea, and vomiting were recorded 10, 20, and 30 min after fentanyl, and every 30 min thereafter until first request for additional analgesia. RESULTS: Adequate analgesia was achieved in 87% (28/32), 94% (35/38), and 94% (31/33) in the fentanyl 50, 75, and 100 microg groups within 20 min. Mean duration of analgesia before re-dosing was significantly longer in fentanyl 100 and 75 microg groups (185.6+/-82.9 and 188.5+/-82.2 min, respectively) as compared with fentanyl 50 microg group (133.6+/-46.2 min, P<0.016). There was no difference in the incidence of maternal side effects or neonatal Apgar scores among the three groups. CONCLUSION: After a test dose of lidocaine-epinephrine, the three epidural fentanyl doses produced similar effective labor analgesia. However, epidural fentanyl 75 microg followed by epidural infusion of dilute bupivacaine and fentanyl produced longer duration of analgesia than fentanyl 50 microg followed by the same infusion, with no further prolongation when the dose of fentanyl was increased up to 100 microg.

Progressive hypoxemia, hypercarbia and hyperthermia associated with prolonged anesthesia--a case report.

The authors report a case of 66-year-old female patient, 55 kg, ASA I who, under general anesthesia in supine position, developed gradual hypoxemia (from a baseline PaO2 of 250 to 91 mmHg), carbon dioxide build up (from a baseline PaCO2 31 to 41 mmHg) associated with gradual hyperthermia up to 38.3 degrees C over seven hours, intraoperatively. These observations were noted while using a semi-closed carbon dioxide absorption circuit in conjunction with the Hygroster filter at a fresh gas flow of 4 1/min of 50% nitrous oxide in oxygen. While the ventilation pattern was unchanged throughout the procedure, there was a change in exhaled tidal and minute ventilation volume with a net decrease of 28 ml and 0.4 l/min respectively. Findings are probably the result of pulmonary atelecatasis under general anesthesia due to the use of a relatively high-inspired oxygen concentration (50%). In addition, the use of a high humidity and temperature heat moisture exchanger (HME) filter (Hygroster) in conjunction with the circle absorber system may have resulted in over humidification and aggravated the pulmonary atelecatasis over the long operative time.

Does postdural puncture headache left untreated lead to subdural hematoma? Case report and review of the literature.

The patient was a 39-year-old pregnant woman who was scheduled for cesarean section. Spinal anesthesia was induced using a 26-gauge needle with an atraumatic bevel. Postoperatively, the patient developed cranial subdural hematoma manifesting as severe non-postural headache, associated with right eye tearing, fifth cranial nerve palsy and left hemiparesis. The diagnosis was confirmed by computed tomography scan. The patient was managed by careful neurological follow-up associated with conservative treatment and recovered fully after 12 weeks. Our report reviews the literature on 46 patients who developed a postdural puncture headache complicated by subdural hematoma following spinal or epidural anesthesia. It is possible that postdural puncture headache left untreated may be complicated by the development of subdural hematoma. Patients developing a postdural puncture headache unrelieved by conservative measures, as well as the change from postural to non-postural, require careful follow-up for early diagnosis and management of possible subdural hematoma.

ß2-Adrenoceptor agonists as potential therapeutic drugs in diabetic peripheral neuropathy.

OBJECTIVES: the aim of the current study was to assess the effect of a ß2-adrenoceptor agonist; namely salbutamol, on hyperalgesic as well as nerve dysfunction components of diabetic peripheral neuropathy. MATERIAL AND METHODS: the present study was conducted on 60 male Wistar albino rats divided into six groups. Groups I and II were normal control rats injected by a single i.p. injection of normal saline and received 2% gum acacia (Group I) or salbutamol (Group II) for six weeks, starting one week following saline injection. Groups III-VI: rats that were rendered diabetic by a single i.p. injection of STZ and received either 2% gum acacia, salbutamol, salbutamol and propranolol or salbutamol and atenolol, respectively daily orally for six weeks, starting one week following STZ injection. RESULTS: vehicle-treated diabetic rats exhibited: significant sciatic nerve dysfunction in the form of significantly prolonged distal latency and significantly decreased maximum peak and peak to peak amplitude of compound muscular action potential, significant thermal and mechanical hyperalgesia evidenced by significant decrease in hot plate latency, tail-flick latency and vocalization threshold, respectively. Salbutamol administration improved nerve dysfunction as well as thermal and mechanical hyperalgesia. These effects of salbutamol are most likely mediated by ß2-adrenoceptors evidenced by significant abolishment of salbutamol effects after administration of the non-selective rather than the selective beta blockers; propranolol and atenolol, respectively. CONCLUSIONS: chronic administration of salbutamol could ameliorate DPN, an effect which is most likely mediated by ß2-adrenoceptors.

Lidocaine cardioplegia for prevention of reperfusion ventricular fibrillation.

Lidocaine addition to crystalloid cardioplegic solution for prevention of reperfusion ventricular fibrillation after the release of the aortic cross-clamp was studied in 50 patients undergoing coronary artery bypass grafting and in 30 patients undergoing mitral or aortic valve replacement. Twenty-six of the patients undergoing coronary artery bypass grafting received lidocaine, 100 mg/L of cardioplegia, whereas a control group of 24 patients received cardioplegia without lidocaine. In the group undergoing valve replacement, 14 patients received lidocaine cardioplegia and 16 patients served as control. In the coronary artery bypass grafting group, lidocaine cardioplegia reduced significantly the incidence of reperfusion ventricular fibrillation from 100% to 42%. In the valve group, lidocaine cardioplegia also reduced significantly the incidence of reperfusion ventricular fibrillation from 93% to 42%. In both groups, lidocaine cardioplegia decreased the number of direct-current countershocks required to defibrillate the heart, with no significant increase in the incidence of high-grade atrioventricular block.

Diclofenac and/or propacetamol for postoperative pain management after cesarean delivery in patients receiving patient controlled analgesia morphine.

BACKGROUND AND OBJECTIVES: A multimodal approach to postcesarean pain management may enhance analgesia and reduce side effects after surgery. This study evaluates the postoperative analgesic effects of propacetamol and/or diclofenac in parturients undergoing elective cesarean delivery under spinal anesthesia. METHODS: After randomization, 80 healthy parturients received the following: placebo (group M), 100 mg diclofenac rectally every 8 hours (group MD), 2 g propacetamol intravenously every 6 hours (group MP), or a combination of 2 g propacetamol and 100 mg diclofenac (group MDP) as described above. Drugs were administered for 24 hours after surgery. Postoperative pain was controlled with a patient controlled analgesia pump, using morphine. The visual analog scale (VAS) at rest and on coughing, as well as the morphine consumption, were evaluated at 2, 6, and 24 hours postoperatively. Also, the side effects experienced after undergoing the different regimens were compared. RESULTS: The patients' characteristics did not differ significantly between the 4 groups. VAS score at 2 hours, both at rest and on coughing were lower in group MDP and MD compared with group M (P <.05). At 24 hours, there was still a tendency toward lower pain scores in the groups MDP and MD; however, this difference was only statistically significant at rest between the MDP group and the MP and M groups. Morphine consumption at 2, 6, and 24 hours was lower in the MDP and MD groups compared with the MP and M groups (P <.05). The morphine-sparing effect was higher in groups MDP and MD compared with group MP (57% and 46%, respectively, v 8.2%, P <.05). The incidence of side effects was similar in all groups. However, the power of the study was too low to permit an evaluation of potential side effects. CONCLUSION: Diclofenac after cesarean delivery improves analgesia and has a highly significant morphine-sparing effect. We were unable to demonstrate significant morphine-sparing effect of propacetamol or additive effect of propacetamol and diclofenac in this group of patients.

Incidence and monthly prevalence of Gasterophilus spp. larvae (Diptera: Gasterophilidae) in the stomach of donkeys (Equus asinus) in Egypt.

The stomachs of 118 donkeys were examined at postmortem during the period from March 1982 to February 1983 for Gasterophilus spp. larvae. G. intestinalis larvae clustered in groups near the boundary of the glandular and non-glandular epithelium of the stomach and infested 98.3% of the donkeys with highest numbers in July and lowest numbers in October. G. nasalis larvae were mainly attached near the pylorus and first part of the duodenum and infested 87.3% of donkeys with highest incidence in December and lowest in October. The ratio of the second and third instars of G. intestinalis to G. nasalis ranged from 71% to 29%. The percentage of donkeys infested with 1-100, 101-200 and 201-300 larvae was 72.0, 18.6 and 4.3% for G. intestinalis and 76.3, 8.5 and 0.8% for G. nasalis.

Prediction of post-cardiopulmonary bypass cardiac output by venous oximetry.

The present study evaluates two equations for predicting the post-cardiopulmonary bypass cardiac output (CO) in 10 patients undergoing coronary artery bypass grafting. One equation is based on the relationship of CO with mixed venous oxygen saturation (SVO 2), while the second equation is based on the relationship with oxygen extraction (1 - SVO 2). Each patient served as his own control. During bypass, when the patients were normothermic and perfused with a pump flow of 2.4 L/min/m 2, the SVO 2 was monitored by an in-line Bentley oxystat Meter. Just before termination of bypass, the pump flow was decreased to 0.4 L/min/m 2 and the left atrial pressure was increased to 10-15 mmHg; the resulting SVO 2 was recorded. The post-bypass CO was predicted in every patient by the two equations. Immediately after weaning from bypass, the cardiac output was measured by thermodilution. The thermodilutional CO measurement was correlated with the CO predicted by the two equations. Correlation analysis suggests that CO prediction is more accurate and approaches the 1:1 ratio when the calculation of predicted CO is based on the relationship between cardiac output and oxygen extraction.

Gall-bladder interposition: a rare anomaly of the extrahepatic ducts.

Abnormalities in bile ducts pattern occur frequently enough to merit importance during cholecystectomy. A patient with anomalous insertion of both hepatic ducts into the gall-bladder with the cystic duct replacing the common bile duct is described. This case, and related anomalies of the bile ducts, are sufficiently important for us to ascertain their location and pattern prior to removal of the gall-bladder. Inadvertent injury to a normal or aberrant bile duct can result in morbidity and even mortality. Knowledge of the embryogenesis of these anomalies helps in the understanding of the location and pattern of these malformations. Almost all of these unusual bile duct arrangements can be recognised by following the rules of meticulous dissection and accurate knowledge of these anatomical aberrations.

Management of an unusual presentation of foreign body aspiration.

Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.

Blood ordering habits for elective surgery: time for change.

A prospective study was carried out for 6 months to determine the efficacy of blood ordering routines for elective surgery. It was found that only 23% of procedures needed preoperative crossmatching of blood (transfusion index 'TI' greater than 0.5). There was an excessive over-ordering of blood for 77% of the operations (crossmatch/transfusion ratio greater than 2.5). In addition, the transfusion index for the latter group showed that there was no need to prepare blood preoperatively (TI less than 0.5). A transfusion tariff is worked out which abandons crossmatching for the majority of procedures (cholecystectomy, thyroidectomy and surgery for duodenal ulcer excluding gastrectomy). Instead a 'group and screen' policy is suggested.

Conserving blood in preparation for elective surgery.

A prospective study was carried out for a period of 6 months (September 1987 to 28 February 1988) to evaluate the possible misuse of blood transfusion service in the department of surgery, Amiri Teaching Hospital, Kuwait. There was a monthly wastage of 45 +/- 13 units of blood. Five hundred and eleven units of blood were crossmatched but never transfused. The time taken by the blood bank technicians in crossmatching blood which was never used amounted to 54.4% of the normal working hours. An annual loss of about US$25000.00 was calculated to have occurred.

Laparoscopic splenectomy in a patient with acquired angioneurotic edema.

BACKGROUND: We report the case of a 77-year-old female with acquired angioneurotic edema, C1 esterase inhibitor level = 4mg/dL, who was scheduled to undergo laparoscopic splenectomy. METHODS: In the operating room, we administered on call 500 units (UI) of C1 esterase inhibitor concentrate intravenously. Intraoperative hemodynamic instability and generalized blood oozing improved following the administration of aprotinin 250000 UI intravenous (IV) drip. CONCLUSION: We recommend the administration of an antifibrinolytic agent in addition to C1 esterase inhibitor concentrate in patients with acquired angioneurotic edema.

Correlation of the end-tidal PCO2 during laparoscopic surgery with the pH of the gastric juice.

BACKGROUND AND OBJECTIVES: During laparoscopy, the increase of the carbon dioxide tension may increase the synthesis of hydrochloric acid in the parietal cells of the stomach; the source of the secreted hydrogen ions is carbonic acid derived from the hydration of carbon dioxide. The present report tests this hypothesis by correlating the changes of end-tidal PCO2 (ETCO2) with the pH of the gastric juice in patients undergoing laparoscopic cholecystectomy. METHODS: 40 adult patients were investigated: 20 controls, and 20 patients receiving 100 mg nizatidine intravenously, prior to surgery. In both groups, the ETCO2 was measured by capnography and the pH of the gastric juice was monitored before carbon dioxide insufflation and at the end of laparoscopy prior to carbon dioxide deflation. RESULTS: In the control group, the ETCO2 increased following carbon dioxide insufflation from a mean basal value of 30.2 (standard deviation [SD] 4.6) mm Hg to 41.1 (SD 9.5) mm Hg, while the mean pH of the gastric juice decreased significantly from 1.9 (SD 0.4) to 1.27 (SD 0.43). There was a significant negative correlation between the ETCO2 and pH of the gastric juice (r = -0.4). In the Nizatidine group, the ETCO2 also increased following carbon dioxide insufflation from a mean basal value of 30.9 (SD 3.0) mm Hg to 39.4 (SD 5.3) mm Hg. However, in contrast with the control group, the mean pH of the gastric juice did not decrease, but paradoxically increased from 1.68 (SD 0.36) to 3.6 (SD 1.02). CONCLUSIONS: During laparoscopy, the pH of the gastric juice is significantly decreased. This decrease is inversely related to the increase of ETCO2. The preoperative administration of the selective H2-blocker nizatidine can prevent the increase in gastric acidity and can result in a paradoxical increase of pH of the gastric juice.