Role of transcranial direct current stimulation on reduction of postsurgical opioid consumption and pain in total knee arthroplasty: Double randomized clinical trial.

BACKGROUND: Postoperative pain control is an important factor in determining recovery in total knee arthroplasty (TKA).The aim of the study was to assess the efficacy of 4 sessions of transcranial direct current stimulation (tDCS) over primary motor cortex (M1) in patients undergoing unilateral TKA. MATERIALS: Fifty patients undergoing TKA were included in the study. They were divided randomly into two groups (25 patients for each, using closed envelopes): real tDCS (2 mA, 20 min, with anodal stimulation applied over M1 postoperative for 4 consecutive days) and sham tDCS. Opioid consumption was titrated by an anaesthesiologist during the study period and was used as primary outcome. As a secondary outcome, patients were evaluated using Visual Analogue Scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale (LANSS) at baseline, then the 1st, 2nd, 3rd and 4th days after operation. RESULTS: There was no significant difference between real and sham tDCS in any rating scales at baseline. The opioid consumption and LANSS scores decreased more in patients who received real tDCS over the course of the treatment than sham tDCS. Real tDCS was associated with 59% reduction in the titrated analgesia. There was no significant difference between groups (time × groups interaction) in the VAS. CONCLUSION: Since the VAS was constant, repeated sessions of anodal tDCS over M1 with an extra-cephalic cathodal electrode can achieve the same degree of analgesia with less opioid consumption over the postoperative days after TKA. Thus, tDCS is a promising tool in the field of postoperative analgesia. SIGNIFICANCE: The data of the present study suggest that four sessions of transcranial direct current brain stimulation over motor cortex could reduce morphine consumption and pain perception during the postoperative period in total knee arthroplasty.

Effect of probenecid and N'-methylnicotinamide on renal handling of cis-dichlorodiammineplatinum-II in rats.

The renal handling of cisplatin was investigated in Sprague-Dawley rats in the presence and absence of probenecid and N'-methylnicotinamide. The renal clearance of free cisplatin was not significantly different from the glomerular filtration rate. N'-Methylnicotinamide, an organic cation, did not affect cisplatin clearance. Administration of probenecid, an organic anion, resulted in a significant increase in cisplatin clearance to 169% of the glomerular filtration rate. These results suggest that cisplatin or a metabolite is excreted by the kidney by a complex process which includes glomerular filtration, secretion and active reabsorption via the organic acid transport system.

Effects of the diuretics mannitol or acetazolamide on nephrotoxicity and physiological disposition of cisplatin in rats.

The anticancer drug cisplatin has been known to produce severe renal lesions characterized by high levels of blood urea nitrogen (BUN), toxic nephrosis, and platinum (Pt) retention in the kidney. The effect of IV pretreatment with acetazolamide (ACZ) 30 min before or mannitol (MAN) immediately prior to IP administration of 5 mg/kg cisplatin on Pt excretion, tissue distribution, and nephrotoxicity was investigated in male F344 rats. ACZ pretreatment reduced the cisplatin-induced nephrotoxicity, as indicated by only a slight elevation of BUN, a milder histopathologic lesion, and a more rapid recovery of renal function and structure. Although MAN-pretreated animals exhibited similar changes in BUN to ACZ-pretreated animals, the renal damage was similar to that seen in animals treated with cisplatin alone. A reduction of kidney Pt content was observed with both diuretics, although there was significantly less retention after ACZ pretreatment. The diuretic ACZ was more effective than MAN in reducing the renal lesions induced by cisplatin and it might be clinically useful in preventing cisplatin nephrotoxicity.

A psychosocial study of accidental poisoning in Egyptian children.

One hundred and twenty-seven accidentally poisoned children from the emergency room of the Islamic Girls College, Cairo, were compared with an equal number of controls. The highest age incidence for both sexes in poisoned children was 36 months. Males outnumbered females at a ratio of 3:2. Behavioural problems such as hyperactivity, temper tantrums, aggression, stubbornness, nocturnal enuresis and impulsiveness occurred more often in poisoned children than in controls and more often in those (24 patients) referred with accidental poisoning on more than one occasion. The families of poisoned children differed significantly from the controls in their large size, low level of education, disturbed home atmosphere and the accessibility to the child of the poisonous substance.

Amelioration of cisplatin-induced nephrotoxicity by the diuretic acetazolamide in F344 rats.

Renal toxicity following a single iv nonlethal dose (6 mg/kg) of cisplatin (CDDP) was investigated in male F344 rats pretreated with 20 mg/kg of acetazolamide (ACZ) sc 30 minutes before CDDP administration. There was a decrease in nephrotoxicity as indicated by a smaller elevation of BUN, a milder histopathologic lesion, and a more rapid recovery of BUN in ACZ-pretreated animals. Renal platinum content of rats receiving ACZ was significantly lower than that in animals treated with CDDP alone. There was no change in platinum level in the plasma or the liver but there was a decreased platinum excretion in urine during 24 hours after treatment. Reduction of platinum concentration in the kidney might account for protection against the renal toxicity. The diuretic ACZ might be useful in the hydration regimens used clinically to prevent renal toxicity from CDDP.

Cord and maternal glycosylated haemoglobin levels: a study in Sudanese pregnant diabetic women.

Blood glucose and glycosylated haemoglobin levels measured at delivery in 27 normal and 19 diabetic women were compared with those of the corresponding fetuses and their birthweights. In both groups, neonatal blood glucose levels were significantly higher (p much less than 0.001) than the maternal levels despite significantly lower (p much less than 0.001) glycosylated haemoglobin values in the neonates. In the control group, there was a significant correlation of maternal glycosylated haemoglobin with both cord glycosylated haemoglobin and birthweight ratio (p less than 0.01). The same was not obtained in the diabetic group, suggesting a dissociation in glucose homeostasis between the diabetic pregnant mother and her fetus.

Maternal-infant transmission of hepatitis B in Egypt.

In order to determine whether maternal-infant (vertical) transmission of hepatitis B is a common route of infection leading to chronic antigenemia in Egypt, 901 asymptomatic women in labor were evaluated. Forty-three women (4.8 percent) were positive for HBsAg, but only one woman was positive for HBeAg. From one year of observation of children born to 13 of the HBsAg-positive mothers, vertical transmission of hepatitis B was estimated to have occurred in approximately 1.7% of births, with chronic antigenemia resulting from 0.6% of births. It was also possible to observe 29 children born to women negative for HBsAg. Horizontal transmission of hepatitis B occurred in 17.2 percent of these children during the first year of life. Maternal-infant transmission of hepatitis B at birth does not appear to be the predominant mechanism of hepatitis B transmission or a common cause of chronic antigenemia in Egypt. The first year after birth appears to be a more important period of hepatitis B transmission. Therefore, vaccination of all children at birth with hepatitis B vaccine could be an effective vaccine strategy despite a low incidence of vertical hepatitis B transmission.