Pulmonary Hypertension and Right Ventricle: A Pathophysiological Insight.

Background: Pulmonary hypertension (PH) is a pulmonary vascular disease characterized by elevated pulmonary vascular pressure. Long-term PH, irrespective of its etiology, leads to increased right ventricular (RV) pressure, RV hypertrophy, and ultimately, RV failure. Main body: Research indicates that RV failure secondary to hypertrophy remains the primary cause of mortality in pulmonary arterial hypertension (PAH). However, the impact of PH on RV structure and function under increased overload remains incompletely understood. Several mechanisms have been proposed, including extracellular remodeling, RV hypertrophy, metabolic disturbances, inflammation, apoptosis, autophagy, endothelial-to-mesenchymal transition, neurohormonal dysregulation, capillary rarefaction, and ischemia. Conclusions: Studies have demonstrated the significant role of oxidative stress in the development of RV failure. Understanding the interplay among these mechanisms is crucial for the prevention and management of RV failure in patients with PH.

Understanding the kynurenine pathway: A narrative review on its impact across chronic pain conditions.

Chronic pain is a debilitating symptom with a significant negative impact on the quality of life and socioeconomic status, particularly among adults and the elderly. Major Depressive Disorder (MDD) stands out as one of the most important comorbid disorders accompanying chronic pain. The kynurenine pathway serves as the primary route for tryptophan degradation and holds critical significance in various biological processes, including the regulation of neurotransmitters, immune responses, cancer development, metabolism, and inflammation. This review encompasses key research studies related to the kynurenine pathway in the context of headache, neuropathic pain, gastrointestinal disorders, fibromyalgia, chronic fatigue syndrome, and MDD. Various metabolites produced in the kynurenine pathway, such as kynurenic acid and quinolinic acid, exhibit neuroprotective and neurotoxic effects, respectively. Recent studies have highlighted the significant involvement of kynurenine and its metabolites in the pathophysiology of pain. Moreover, pharmacological interventions targeting the regulation of the kynurenine pathway have shown therapeutic promise in pain management. Understanding the underlying mechanisms of this pathway presents an opportunity for developing personalized, innovative, and non-opioid approaches to pain treatment. Therefore, this narrative review explores the role of the kynurenine pathway in various chronic pain disorders and its association with depression and chronic pain.

Effectiveness of Adding Dexamethasone to Lidocaine in Upper Limbs Nerve Blocks: A Systematic Review.

PURPOSE: The use of perineural dexamethasone as an adjuvant drug to peripheral nerve block for postoperative pain is controversial. This systematic review aimed to determine the effectiveness of adding dexamethasone to lidocaine in upper limb nerve blocks. DESIGN: Systematic review. METHODS: This review used a comprehensive search strategy to retrieve relevant published randomized trial articles that fulfilled the inclusion and exclusion criteria, without time limits, (until December 2023) that assessed the effects of a combination of dexamethasone to lidocaine in upper limb nerve blocks. The databases used for the electronic literature search included PubMed, Embase, and Clinical Trials.gov, dbGaP, Cochrane library, and Google Scholar. There was no language, gender, or age limitation. This systematic review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. FINDINGS: Of 3,926 articles identified by the initial search, 8 studies that met our inclusion criteria. All articles were original research studies. All eight articles were clinical trials. The sample size in the selected studies ranged from 30 to 90 people. Studies demonstrated that combining dexamethasone with lidocaine significantly improved the quality of peripheral nerve blocks, increased the analgesia period, and decreased analgesic consumption. CONCLUSIONS: This review supported that the combination of dexamethasone (dose of 4 to 10 mg) and lidocaine (concentration of 1.5% to 2%) for upper limb block was more effective and beneficial without any side effects. However, further clinical trials in this regard with more data, various regions, and larger sample sizes to support our hypothesis are recommended.

Comparing intravenous lidocaine and pethidine for pain management in emergency department patients with femoral bone fracture: a randomized controlled trial.

BACKGROUND: Intravenous lidocaine has shown promise as an effective analgesic in various clinical settings, but its utility for pain management in emergency departments, especially for bone fractures, remains relatively understudied. OBJECTIVE: This study compared intravenous lidocaine to pethidine for femoral bone fracture pain management. METHODS: This double-blind, randomized, controlled clinical trial was conducted in the emergency department of AJA University of Medical Sciences affiliated hospitals. Patients aged 18-70 years-old with femoral bone fracture and experiencing severe pain, defined as a numerical rating scale (NRS) of pain ≥ 7, were included in the study. One group received intravenous pethidine (25 mg), while the other group received intravenous lidocaine (3 mg/kg, not exceeding 200 mg), infused with 250 ml saline over 20 min. Pain levels were evaluated before treatment administration (0 min) and at 10, 20, 30, 40, 50, and 60 min after treatment administration using the NRS. RESULTS: Seventy-two patients were enrolled in the study. Demographic characteristics and pain scores were similar between the two groups. The mean pain scores upon arrival for the lidocaine and pethidine groups were 8.50 ± 1 and 8.0 ± 1, respectively; after one hour, they were 4.0 ± 1 and 4.0 ± 1, respectively. While there was a statistically significant reduction in pain in both groups after one hour, there were no clinically or statistically significant differences between the two groups (p = 0.262). Pethidine had a higher incidence of adverse events, though not statistically significant. Additionally, females required more rescue analgesics. CONCLUSION: The administration of intravenous lidocaine is beneficial for managing pain in femoral bone fractures, suggesting that lidocaine could be a potent alternative to opioids. TRIAL REGISTRATION: IRCT20231213060355N1 ( https://irct.behdasht.gov.ir/trial/74624 ) (30/12/2023).

Comparing laryngeal view in neutral and sniff position during video laryngoscopy-guided intubation.

Appropriate positioning of the head is a crucial step for a successful intubation. Laryngoscopy is a commonly used method to facilitate the intubation process. This study evaluated the quality of intubation and its difficulty in sniff and neutral position. This was a clinical randomized trial, conducted in 2021 in Aja university of medical sciences. 40 patients, meeting the inclusion criteria were randomly assigned to sniff and neutral group and were intubated with standard procedure. The required time, number of attempts, laryngeal view, cord status, and the need for maneuver were evaluated between the two positions. Overall, 60 patients were intubated in sniff and 60 in neutral position. 51 of them were male and 69 were female. The mean intubation time was (17/15 ± 8/00) and (16/65 ± 8/66) seconds in neutral and sniff position, respectively (p-value = 0.181). There was no statistically significant difference in the required time. Additionally, 45 patients were intubated in first attempt and 15 were intubated after the second attempt in each group. There was no difference in any difficulty-related parameter of the two groups. No significant difference between the required time, attempt, or any other parameter was detected between the sniff and neutral groups. Evidence suggests that there is no superiority regarding these two positions and the decision should be made by the physician on a case-by-case basis.

Weaning of septic patients from the ventilator in the intensive care unit by attention approach to common antibiotic regimens.

Background: Sepsis is a chronic blood infection that is more common in patients with ventilatory and disability. This study aimed to evaluate the effect of common antibiotic regimens on weaning sepsis patients from mechanical ventilator. Methods: In this prospective cross-sectional study, we classified 70 sepsis patients under mechanical ventilation which sedates with midazolam and do not take muscle relaxants into two groups: meropenem and levofloxacin versus meropenem, levofloxacin, and clindamycin. The duration of intubation and the number of patients who needed re-intubation (and their duration of extubation) were recorded. Data were analyzed using SPSS software. Results: In the present study, 68.6% were male and 31.4% were female. The mean age was calculated to be 37.98. The mean duration of mechanical ventilation and stay in the ICU in the group of two drugs (meropenem + levofloxacin) showed a significant decrease compared to the group of three drugs (P < 0.05). But no significant difference was observed in terms of ventilator connection time (P < 0.05). Conclusion: The differences in terms of mean duration of mechanical ventilation and ICU stay between the groups indicate that the two-drug regimen (meropenem + levofloxacin) is more efficient in bringing [sepsis] patients back to recovery.