Postoperative Sore Throat among Patients Following General Anesthesia with Endotracheal Intubation in a Tertiary Care Centre.

Introduction: Postoperative sore throat is the second most common minor adverse event after general anaesthesia with endotracheal intubation. It is an uncomfortable and stressful sequel of tracheal intubation. The incidence of postoperative sore throat varies across different studies and type of anesthesia technique used. The aim of the study was to find out the prevalence of postoperative sore throat following general anaesthesia with endotracheal intubation in a tertiary care centre. Methods: A descriptive cross-sectional study was conducted among the patients who underwent surgery under general anaesthesia with endotracheal intubation from 1 December 2022 to 31 October 2023 after receiving ethical approval from the Institutional Review Committee. The anaesthesia technique was standardized in all the patients. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results: Among 200 patients, postoperative sore throat was seen in 86 (43%) (36.14-49.86, 95% Confidence Interval) patients. The maximum reported time of sore throat was at a fourth postoperative hour 80 (93.02%). Conclusions: The prevalence of postoperative sore throat among patients undergoing surgery under general anaesthesia with endotracheal intubation was similar to the studies conducted in similar settings. Keywords: endotracheal intubation; general anaesthesia; prevalence.

Changes in the proteome and secretome of rat liver sinusoidal endothelial cells during early primary culture and effects of dexamethasone.

INTRODUCTION: Liver sinusoidal endothelial cells (LSECs) are specialized fenestrated scavenger endothelial cells involved in the elimination of modified plasma proteins and tissue turnover waste macromolecules from blood. LSECs also participate in liver immune responses. A challenge when studying LSEC biology is the rapid loss of the in vivo phenotype in culture. In this study, we have examined biological processes and pathways affected during early-stage primary culture of rat LSECs and checked for cell responses to the pro-inflammatory cytokine interleukin (IL)-1ß and the anti-inflammatory drug dexamethasone. METHODS: LSECs from male Sprague Dawley rats were cultured on type I collagen in 5% oxygen atmosphere in DMEM with serum-free supplements for 2 and 24 h. Quantitative proteomics using tandem mass tag technology was used to examine proteins in cells and supernatants. Validation was done with qPCR, ELISA, multiplex immunoassay, and caspase 3/7 assay. Cell ultrastructure was examined by scanning electron microscopy, and scavenger function by quantitative endocytosis assays. RESULTS: LSECs cultured for 24 h showed a characteristic pro-inflammatory phenotype both in the presence and absence of IL-1ß, with upregulation of cellular responses to cytokines and interferon-γ, cell-cell adhesion, and glycolysis, increased expression of fatty acid binding proteins (FABP4, FABP5), and downregulation of several membrane receptors (STAB1, STAB2, LYVE1, CLEC4G) and proteins in pyruvate metabolism, citric acid cycle, fatty acid elongation, amino acid metabolism, and oxidation-reduction processes. Dexamethasone inhibited apoptosis and improved LSEC viability in culture, repressed inflammatory and immune regulatory pathways and secretion of IL-1ß and IL-6, and further upregulated FABP4 and FABP5 compared to time-matched controls. The LSEC porosity and endocytic activity were reduced at 24 h both with and without dexamethasone but the dexamethasone-treated cells showed a less stressed phenotype. CONCLUSION: Rat LSECs become activated towards a pro-inflammatory phenotype during early culture. Dexamethasone represses LSEC activation, inhibits apoptosis, and improves cell viability.

Intrathecal morphine does not prevent chronic postsurgical pain after elective Caesarean delivery: a randomised controlled trial.

BACKGROUND: Morphine is frequently added to spinal anaesthesia for Caesarean delivery. We aimed to determine whether intrathecal morphine for spinal anaesthesia decreases the risk of chronic postsurgical pain (CPSP). METHODS: In this randomised, double-blind, placebo-controlled trial, 290 healthy parturients undergoing elective Caesarean delivery were randomly assigned in a 1:1 ratio to receive either intrathecal morphine 100 µg (n=145) or normal saline (control; n=145) as a part of spinal anaesthesia. Anaesthetic care and postoperative pain management were standardised in all patients. The primary outcome was the incidence of CPSP at 3 months. Secondary outcomes included CPSP at 6 months, pain severity, and pain interference, measured by the Brief Pain Inventory questionnaire using an 11-point numeric rating scale, at 3 and 6 months after the surgery. RESULTS: Two hundred and seventy-six patients completed the 3-month follow-up, 139 in the morphine group and 137 in the placebo group. The incidences of CPSP at 3 months were 19% (27 of 139) in the morphine group and 18% (25 of 137) in the placebo group (odds ratio, 1.08; 95% confidence interval, 0.59-1.97; P=0.803). At 6 months, CPSP was present in 23 of 139 (16%) morphine group patients compared with 19 of 137 (14%) in the placebo group (odds ratio, 1.23; 95% confidence interval, 0.63-2.38; P=0.536). Brief Pain Inventory questionnaire scores for pain severity and pain interference at 3 and 6 months were similar between groups. CONCLUSIONS: Administration of morphine 100 µg as a component of spinal anaesthesia for elective Caesarean delivery failed to reduce the incidence of chronic pain at 3 and 6 months after surgery. CLINICAL TRIAL REGISTRATION: NCT03451695.

The Scavenger Function of Liver Sinusoidal Endothelial Cells in Health and Disease.

The aim of this review is to give an outline of the blood clearance function of the liver sinusoidal endothelial cells (LSECs) in health and disease. Lining the hundreds of millions of hepatic sinusoids in the human liver the LSECs are perfectly located to survey the constituents of the blood. These cells are equipped with high-affinity receptors and an intracellular vesicle transport apparatus, enabling a remarkably efficient machinery for removal of large molecules and nanoparticles from the blood, thus contributing importantly to maintain blood and tissue homeostasis. We describe here central aspects of LSEC signature receptors that enable the cells to recognize and internalize blood-borne waste macromolecules at great speed and high capacity. Notably, this blood clearance system is a silent process, in the sense that it usually neither requires or elicits cell activation or immune responses. Most of our knowledge about LSECs arises from studies in animals, of which mouse and rat make up the great majority, and some species differences relevant for extrapolating from animal models to human are discussed. In the last part of the review, we discuss comparative aspects of the LSEC scavenger functions and specialized scavenger endothelial cells (SECs) in other vascular beds and in different vertebrate classes. In conclusion, the activity of LSECs and other SECs prevent exposure of a great number of waste products to the immune system, and molecules with noxious biological activities are effectively "silenced" by the rapid clearance in LSECs. An undesired consequence of this avid scavenging system is unwanted uptake of nanomedicines and biologics in the cells. As the development of this new generation of therapeutics evolves, there will be a sharp increase in the need to understand the clearance function of LSECs in health and disease. There is still a significant knowledge gap in how the LSEC clearance function is affected in liver disease.

Mucormycosis: An unanticipated progeny of COVID-19.

The rapid surge of COVID-19 cases in the second wave of the pandemic has crippled the healthcare delivery system in Nepal and neighboring countries. Unlike in the first wave of the pandemic, several cases of mucormycosis have been reported in patients with COVID-19 from Nepal and India. In this report, we briefly describe the clinical presentation, diagnosis, and risk factors for mucormycosis and explore why patients with COVID-19 are at an increased risk for developing the infection. As treatment of mucormycosis is challenging and consumes a lot of resources, prevention of mucormycosis is pivotal in low-income countries like Nepal. We also highlight some basic steps that are easy to perform and important to reduce the risk of infection.

Frontline Healthcare Workers' Knowledge and Perception of COVID-19, and Willingness to Work during the Pandemic in Nepal.

This study investigated the contextual factors associated with the knowledge, perceptions, and the willingness of frontline healthcare workers (FHWs) to work during the COVID-19 pandemic in Nepal among a total of 1051 FHWs. Multivariable logistic regression analysis was applied to identify independent associations between predictors and outcome variables. Of the total study subjects, 17.2% reported inadequate knowledge on COVID-19, 63.6% reported that they perceived the government response as unsatisfactory, and 35.9% showed an unwillingness to work during the pandemic. Our analyses demonstrated that FHWs at local public health facilities, pharmacists, Ayurvedic health workers (HWs), and those with chronic diseases were less likely, and male FHWs were more likely, to have adequate knowledge of COVID-19. Likewise, nurses/midwives, public health workers, FHWs from Karnali and Far-West provinces, and those who had adequate knowledge of COVID-19 were more likely to have satisfactory perceptions towards the government response. Further, FHWs-paramedics, nurse/midwives, public health workers, laboratory workers-FHWs from Karnali Province and Far-West Province, and those with satisfactory perceptions of government responses to COVID-19 were predictors of willingness to work during the COVID-19 pandemic. These results suggest that prompt actions are required to improve FHWs' knowledge of COVID-19, address negative perceptions of government responses, and motivate them through specific measures to provide healthcare services during the pandemic.

Transcriptome and proteome profiling reveal complementary scavenger and immune features of rat liver sinusoidal endothelial cells and liver macrophages.

BACKGROUND: Liver sinusoidal endothelial cells (LSECs) and Kupffer cells (KCs; liver resident macrophages) form the body's most effective scavenger cell system for the removal of harmful blood-borne substances, ranging from modified self-proteins to pathogens and xenobiotics. Controversies in the literature regarding the LSEC phenotype pose a challenge when determining distinct functionalities of KCs and LSECs. This may be due to overlapping functions of the two cells, insufficient purification and/or identification of the cells, rapid dedifferentiation of LSECs in vitro, or species differences. We therefore characterized and quantitatively compared expressed gene products of freshly isolated, highly pure LSECs (fenestrated SE-1/FcγRIIb2+) and KCs (CD11b/c+) from Sprague Dawley, Crl:CD (SD), male rats using high throughput mRNA-sequencing and label-free proteomics. RESULTS: We observed a robust correlation between the proteomes and transcriptomes of the two cell types. Integrative analysis of the global molecular profile demonstrated the immunological aspects of LSECs. The constitutive expression of several immune genes and corresponding proteins of LSECs bore some resemblance with the expression in macrophages. LSECs and KCs both expressed high levels of scavenger receptors (SR) and C-type lectins. Equivalent expression of SR-A1 (Msr1), mannose receptor (Mrc1), SR-B1 (Scarb1), and SR-B3 (Scarb2) suggested functional similarity between the two cell types, while functional distinction between the cells was evidenced by LSEC-specific expression of the SRs stabilin-1 (Stab1) and stabilin-2 (Stab2), and the C-type lectins LSECtin (Clec4g) and DC-SIGNR (Clec4m). Many immune regulatory factors were differentially expressed in LSECs and KCs, with one cell predominantly expressing a specific cytokine/chemokine and the other cell the cognate receptor, illustrating the complex cytokine milieu of the sinusoids. Both cells expressed genes and proteins involved in antigen processing and presentation, and lymphocyte co-stimulation. CONCLUSIONS: Our findings support complementary and partly overlapping scavenging and immune functions of LSECs and KCs. This highlights the importance of including LSECs in studies of liver immunity, and liver clearance and toxicity of large molecule drugs and nano-formulations.

Postoperative Visual Loss Following Spine Surgery: A Case Report.

Postoperative visual loss is a rare but devastating complication of non-ophthalmic surgery. Its aetiology is poorly understood and multiple associated factors have been proposed. We present a report of a 33-year-old female who developed irreversible diminution of vision on the right eye (non-arteritic-posterior-ischemic-optic-neuropathy) following general anaesthesia for pedicle screw fixation and plating for fracture vertebrae and hip in prone position and then screw placement for fracture calcaneum in supine position. The vision loss, limited to finger count close to face on the right eye, did not improve till follow-up at one-year. The combination of mild intraoperative hypotension, anaemia, prone positioning, prolonged surgery and anaesthesia may have contributed to postoperative visual loss in our patient. Keywords: ischaemic optic neuropathy; postoperative visual loss; spine surgery.

Connective tissue growth factor is activated by gastrin and involved in gastrin-induced migration and invasion.

Connective tissue growth factor (CTGF) has been reported in gastric adenocarcinoma and in carcinoid tumors. The aim of this study was to explore a possible link between CTGF and gastrin in gastric epithelial cells and to study the role of CTGF in gastrin induced migration and invasion of AGS-GR cells. The effects of gastrin were studied using RT-qPCR, Western blot and assays for migration and invasion. We report an association between serum gastrin concentrations and CTGF abundancy in the gastric corpus mucosa of hypergastrinemic subjects and mice. We found a higher expression of CTGF in gastric mucosa tissue adjacent to tumor compared to normal control tissue. We showed that gastrin induced expression of CTGF in gastric epithelial AGS-GR cells via MEK, PKC and PKB/AKT pathways. CTGF inhibited gastrin induced migration and invasion of AGS-GR cells. We conclude that CTGF expression is stimulated by gastrin and involved in remodeling of the gastric epithelium.

A Priority-Based Adaptive MAC Protocol for Wireless Body Area Networks.

In wireless body area networks (WBANs), various sensors and actuators are placed on/inside the human body and connected wirelessly. WBANs have specific requirements for healthcare and medical applications, hence, standard protocols like the IEEE 802.15.4 cannot fulfill all the requirements. Consequently, many medium access control (MAC) protocols, mostly derived from the IEEE 802.15.4 superframe structure, have been studied. Nevertheless, they do not support a differentiated quality of service (QoS) for the various forms of traffic coexisting in a WBAN. In particular, a QoS-aware MAC protocol is essential for WBANs operating in the unlicensed Industrial, Scientific, and Medical (ISM) bands, because different wireless services like Bluetooth, WiFi, and Zigbee may coexist there and cause severe interference. In this paper, we propose a priority-based adaptive MAC (PA-MAC) protocol for WBANs in unlicensed bands, which allocates time slots dynamically, based on the traffic priority. Further, multiple channels are effectively utilized to reduce access delays in a WBAN, in the presence of coexisting systems. Our performance evaluation results show that the proposed PA-MAC outperforms the IEEE 802.15.4 MAC and the conventional priority-based MAC in terms of the average transmission time, throughput, energy consumption, and data collision ratio.

A Survey of MAC Protocols for Cognitive Radio Body Area Networks.

The advancement in electronics, wireless communications and integrated circuits has enabled the development of small low-power sensors and actuators that can be placed on, in or around the human body. A wireless body area network (WBAN) can be effectively used to deliver the sensory data to a central server, where it can be monitored, stored and analyzed. For more than a decade, cognitive radio (CR) technology has been widely adopted in wireless networks, as it utilizes the available spectra of licensed, as well as unlicensed bands. A cognitive radio body area network (CRBAN) is a CR-enabled WBAN. Unlike other wireless networks, CRBANs have specific requirements, such as being able to automatically sense their environments and to utilize unused, licensed spectra without interfering with licensed users, but existing protocols cannot fulfill them. In particular, the medium access control (MAC) layer plays a key role in cognitive radio functions, such as channel sensing, resource allocation, spectrum mobility and spectrum sharing. To address various application-specific requirements in CRBANs, several MAC protocols have been proposed in the literature. In this paper, we survey MAC protocols for CRBANs. We then compare the different MAC protocols with one another and discuss challenging open issues in the relevant research.