Effect of ondansetron compared to lidocaine and placebo for reducing propofol injection pain: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Propofol is the most commonly used intravenous anesthetic medication and is most commonly associated with post-operative pain. Several drugs are investigated to reduce post-operative pain caused by propofol injection. Ondansetron is a potent anti-emetic drug showing promising results as an analgesic. This meta-analysis aims to compare the efficacy of ondansetron to placebo and lidocaine in reducing post-operative pain caused by propofol injection. METHODS: PubMed, Embase, Cochrane Library, Web of Science, and Scopus were searched for relevant randomized controlled trials (RCTs) till May 2022. We conducted a meta-analysis using RevMan software version 5.4, and we assessed the quality of included RCTs using the Cochrane risk of bias tool. RESULTS: In our study, we included 23 RCTs with 2957 participants. Compared to placebo, ondansetron significantly increased the rate of no pain [risk ratio (RR) = 2.36, 95% confidence interval (CI) (1.39-4.01)], and reduced moderate [RR = 0.39, 95% CI (0.30-0.52)] and severe pain [RR = 0.34, 95% CI (0.24-0.50)]. Furthermore, ondansetron significantly reduced PONV [RR = 0.73, 95% CI (0.58, 0.91)]. On the other hand, ondansetron showed an inferior efficacy to lidocaine regarding the incidence of no, moderate, and severe pain. CONCLUSION: Ondansetron is effective in reducing post-operative propofol-induced pain. However, lidocaine is more effective than it.

Racial Disparity in Anthracycline-induced Cardiotoxicity in Breast Cancer Patients.

Breast cancer has become the most common cancer in the US and worldwide. While advances in early detection and treatment have resulted in a 40% reduction in breast cancer mortality, this reduction has not been achieved uniformly among racial groups. A large percentage of non-metastatic breast cancer mortality is related to the cardiovascular effects of breast cancer therapies. These effects appear to be more prevalent among patients from historically marginalized racial/ethnic backgrounds, such as African American and Hispanic individuals. Anthracyclines, particularly doxorubicin and daunorubicin, are the first-line treatments for breast cancer patients. However, their use is limited by their dose-dependent and cumulative cardiotoxicity, manifested by cardiomyopathy, ischemic heart disease, arrhythmias, hypertension, thromboembolic disorders, and heart failure. Cardiotoxicity risk factors, such as genetic predisposition and preexisting obesity, diabetes, hypertension, and heart diseases, are more prevalent in racial/ethnic minorities and undoubtedly contribute to the risk. Yet, beyond these risk factors, racial/ethnic minorities also face unique challenges that contribute to disparities in the emerging field of cardio-oncology, including socioeconomic factors, food insecurity, and the inability to access healthcare providers, among others. The current review will address genetic, clinical, and social determinants that potentially contribute to this disparity.

Timely Management of Obstructive Prosthetic Valve Thrombosis.

Obstructive bioprosthetic valve thrombosis is associated with hemodynamic compromise, and evidence on management with fibrinolysis is limited. Echocardiography is required to assess thrombus size and its effects on valve gradients, area, and leaflet motion. This case demonstrates use of echocardiography guided slow-infusion low-dose fibrinolytic therapy in a patient with obstructive bioprosthetic valve thrombosis. (Level of Difficulty: Intermediate.).

Sixty-four multi-detector computerised tomography in the detection of lower gastrointestinal bleeding: A prospective study.

INTRODUCTION: Acute gastrointestinal bleeding (AGIB) is a serious and life-threatening condition. Many diagnostic procedures and tests are being used to detect the site of bleeding with different success rates. The aim of our study is to prospectively evaluate accuracy of 64-slice multi-detector computerised tomography (MDCT) in the diagnosis of lower AGIB. METHODS: Between September 2007 and January 2009, patients with presumed lower AGIB were referred to the radiology department of our institution for 64-slice MDCT examination as part of the investigation for the lower AGIB. Any abnormalities to account for bleeding, such as tumours, bowel wall enhancement and increased intraluminal density, were recorded. RESULTS: Out of 139 patients with AGIB that were admitted to our casualty department, 27 patients (19 men and 8 women) in the age range of 24-88 years (mean age, 56 years) were suspected to have lower AGIB. Sixty-four-slice MDCT was performed and considered positive for bleeding in 19 (70%) cases, and in all the cases, the bleeding source was indentified in the arterial phase, showing a focal dense wall enhancement in 8 (42%) cases, circumferential wall enhancement in 4 (22%) cases and progressive increasing intraluminal density in 7 (36%) cases. The venous phase scan showed increased dispersion of the contrast within the lumen as an additional clue for active extravasation in 15 (79%) out of the 19 cases. Delayed 5-min scanning showed the same findings as venous phase in all the 19 positive cases and failed to depict any additional findings in the eight cases that were negative on arterial or venous phases. CONCLUSION: The study supports the high accuracy of 64-slice MDCT in locating the site of AGIB in patients thought to have a distal source of bleeding. Its accuracy in clinically proximal bleeding is not clear from this study, but MDCT is capable of showing such sources.

Enormous brachio-cephalic arteriovenous fistula aneurysm after renal transplantation: case report and review of the literature.

Creation of arteriovenous fistulae provides readily available vascular access for haemodialysis in patients with end-stage renal disease. However, it is associated with various potentially serious complications if left unattended. We report a case of a 73-year-old male presenting with an enormous brachio-cephalic fistula aneurysm measuring 70-5.4 cm 20 years after successful renal transplantation. Despite attending regular renal outpatient clinic follow-up, this was only noticed as an incidental finding when the patient attended the emergency department after a fall that severely bruised his access. The patient subsequently underwent ligation with complete removal of the aneurismal fistula and discharged to a rehabilitation unit 3 days post-operatively. Systematic closure of an arteriovenous fistula should be considered in all patients after successful renal transplantation to avoid potentially catastrophic complications of an arteriovenous fistula. In patients in whom the closure of vascular access is contraindicated, it is crucial to regularly assess the status of any arteriovenous fistula when following up patients after renal transplantation.

Enhancing the survival of tunneled haemodialysis catheters using an antibiotic lock in the elderly: a randomised, double-blind clinical trial.

BACKGROUND: Tunneled-cuffed catheters (TCC) are often used among the elderly to commence and carry out haemodialysis (HD). Complications like infection and thrombosis frequently reduce the lifespan of TCC. The role of an antibiotic heparin 'lock' in the prevention of thrombotic and infectious complications and enhancement of TCC survival in the elderly has not been investigated previously. METHODS: In this prospective, double-blind clinical trial, TCC (n = 119, placed among 113 elderly patients requiring HD during March 2002 - February 2003) were randomised to either group I having TCC (n = 59, placed in 58 elderly patients) locked with cefotaxime (10 mg/mL) and heparin (5000 U/mL), or group II with TCC (n = 60, placed in 55 elderly patients) having catheter-restricted filling of heparin (5000 U/mL) alone. Symptomatic catheter-related blood stream infections (CRBSI) and catheter thrombosis were the primary end points in this study. Thrombosis was defined as an inability to use the catheter at a blood flow of 200 mL/min that did not respond to catheter repositioning and/or intraluminal thrombolysis. The incidence of catheter thrombosis, CRBSI and percentage of catheter survival were estimated and statistically compared between the two groups. RESULTS: Kaplan-Meier survival analysis using log rank test showed higher thrombosis-free TCC survival (84.7%vs 63.3%, P = 0.021), infection-free survival (68.7%vs 31.3%, P < 0.001) and infection and thrombosis-free survival (65.0%vs 35.0%, P = 0.006) at 365 days in group I compared with group II. CONCLUSION: Cefotaxime and heparin locks safely and effectively enhance the lifespan of TCC by lowering the incidence of thrombotic and infectious complications among elderly end-stage renal failure (ESRD) patients.

Cytotoxic effects of a decoction of Nigella sativa, Hemidesmus indicus and Smilax glabra on human hepatoma HepG2 cells.

A decoction of Nigella sativa seeds, Hemidesmus indicus root and Smilax glabra rhizome is used by traditional medical practitioners in Sri Lanka to treat cancer and has been shown to prevent chemically induced carcinogenesis in rats. The cytotoxicity of the decoction and the individual plant extracts were tested on the human hepatoma HepG2 cell line. The effects of 24 h incubation with different concentrations (0--50 mg/ml) of the extracts on HepG2 cells were determined. Results from MTT and SRB assays, and [(14)C]-leucine and [(3)H]-thymidine uptake demonstrated that the decoction had a strong dose-dependent cytotoxic activity. The greatest inhibitory effects were observed on DNA synthesis with both the decoction (91+/-S.E. 3.7% inhibition) and N. sativa plant extract (88+/-3.8%) even at low concentrations (5 mg/ml). The three individual plant extracts were cytotoxic in the order of potency N. sativa>H. indicus>S. glabra. Flow cytometric analysis using Annexin V and propidium iodide staining showed that after 24 h exposure to the decoction, cells were in the late stage of apoptosis and/or necrosis. Further experiments are worthwhile to determine the anticancer potential of this plant decoction and its components.

Metal-dependent ferro- versus antiferromagnetic interactions in molecular crystals of square Planar (M(II) imino-nitroxide radical) complexes (M = Pt, Pd).

The synthesis and structural, spectral, and magnetic characterizations of two new complexes of formula [Pt(IM(2)Py)Cl(2)] (A) and [Pd(IM(2)Py)Cl(2)] (B) are reported. IM(2)Py stands for the imino-nitroxide radical ligand 2-(ortho-pyridyl)-4,4,5,5-tetramethylimidazoline-1-oxyl. Their crystal structures were solved at room temperature and at 120 K revealing structural phase transitions from pseudo-orthorhombic to monoclinic systems for the two compounds which remain isostructural in the whole temperature range explored. Structural parameters for A: T = 293 K [120 K], monoclinic (P2(1)/n) [P2(1)/c], a = 7.906(2) [7.989(3)] A, b = 17.872(9) [10.168(4)] A, c = 10.357(3) [17.623(6)] A, beta = 90.732(13) degrees [95.940(2)] degrees, Z = 4 [4]. Structural parameters for B: T = 293 K [120 K], monoclinic (P2(1)/n) [P2(1)/c], a = 7.900(3) [7.9730(2)] A, b = 17.907(9) [10.1806(3)] A, c = 10.299(3) [17.7171(4)] A, beta = 90.524(14) degrees [95.747(2)] degrees, Z = 4 [4]. In both complexes, the metal coordination is essentially planar. The average Pt-N, Pt-Cl and Pd-N, Pd-Cl bond lengths are 1.996(6) [1.88], 2.295(2) [2.248(8)] A and 2.015(7) [2.029(8)], 2.287(3) [2.294(3)] A, respectively. The solid state structure is characterized by a pairlike molecular packing stacked in columns parallel to the a axis; this dimer character is reinforced at low temperature. Despite their structural similarity, the investigation of the magnetic properties revealed that dominant ferromagnetic interactions govern the behavior of the Pt derivative A, whereas antiferromagnetic interactions take place for the Pd compound B. A rationalization for this rather intriguing difference is proposed in light of the spin population deduced from density functional theory calculations. The electronic absorption spectra of A and B present structured absorption bands in the visible which are attributed to MLCT transitions. Both compounds are nonluminescent at room temperature. However, a weak emission is detected for A in butyronitrile glasses at 77 K, indicating that the MLCT excited state is strongly quenched at low temperature.