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1.
Biol Pharm Bull ; 45(9): 1254-1258, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36047193

RESUMO

Cytotoxic agents are classified according to the severity of skin injury after extravasation. However, injuries caused by extravasation of noncytotoxic agents have not been sufficiently investigated, although the risk of extravasation is mentioned in medical safety information published by the Japan Council for Quality Health Care. Therefore, in this study, we focused on noncytotoxic electrolyte solutions and infusions and evaluated skin injuries during leakage using extravasation model rats. Rats were anesthetized and intradermally injected with 100 µL of an electrolyte solution or infusion. Injection lesions were macroscopically and histopathologically evaluated for extravasation injuries. Each electrolyte solution and infusion were classified into three categories (vesicants, irritants, and non-tissue-damaging agents) depending on the degree of skin injury. Similar to saline, 0.3% potassium chloride and 0.6% magnesium sulfate showed almost no injury, and 3% sodium chloride and BFLUID® caused erythema and induration. Erythema, induration, and ulceration were observed with the following: 10% sodium chloride, 2% calcium chloride, 8.5% calcium gluconate, 12.3% magnesium sulfate, MAGSENT®, FESIN®, and Intralipos®. The duration of damage with these agents was markedly prolonged. Electrolyte solutions and infusions can be classified into vesicants (10% sodium chloride, 2% calcium chloride, 8.5% calcium gluconate, 12.3% magnesium sulfate, MAGSENT®, FESIN®, and Intralipos®), irritants (3% sodium chloride and BFLUID®), and non-tissue-damaging agents (0.3% potassium chloride and 0.6% magnesium sulfate) according to their composition. The characteristic symptoms and severity of each drug extravasation revealed in this study will provide basic information for preparation of guidelines for treatment of extravasation.


Assuntos
Gluconato de Cálcio , Sulfato de Magnésio , Animais , Cloreto de Cálcio , Eletrólitos , Eritema , Infusões Intravenosas , Irritantes , Sulfato de Magnésio/efeitos adversos , Cloreto de Potássio , Ratos , Cloreto de Sódio
2.
BMC Oral Health ; 22(1): 408, 2022 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-36123724

RESUMO

OBJECTIVE: Myofascial pain syndrome with trigger points is the most common cause of nonodontogenic pain. Although injection of the trigger points is the most effective pain reduction treatment, many patients exhibit recurrence after a short period. Therefore, the aim of the current study was to evaluate the clinical efficacy of magnesium sulfate injections in the treatment of the masseter muscle trigger points when compared to saline injections. MATERIAL AND METHOD: This study randomly (1:1) assigned 180 patients to one of two treatment groups based on whether their trigger points were injected with 2 ml of saline or magnesium sulfate. Pain scores, maximum mouth opening (MMO), and quality of life were measured at the pre-injection and 1, 3, and 6 months post-injection. RESULTS: The pain scores were significantly higher in the saline group during all follow-up assessments, whereas the MMO was significantly higher in the magnesium sulfate group up to 3 months of follow-up (p < 0.001). However, the difference in MMO ceased to be statistically significant after 6 months of follow-up (p = 0.121). Additionally, the patient's quality of life score was significantly higher in the magnesium sulfate group compared to the saline group (p < 0.001). CONCLUSION: Injection of magnesium sulfate is an effective treatment measure for myofascial trigger points. However, further studies with a proper design addressing the limitations of the current study are necessary. CLINICALTRIALS: org (ID: NCT04742140) 5/2/2021.


Assuntos
Músculo Masseter , Pontos-Gatilho , Humanos , Sulfato de Magnésio/uso terapêutico , Dor , Qualidade de Vida , Resultado do Tratamento
3.
Medicine (Baltimore) ; 101(37): e30571, 2022 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-36123883

RESUMO

RATIONALE: Thus far, barium poisoning has been seldom reported and the metabolism of barium in human body has not been explored. PATIENT CONCERNS: A 21-year-old young man was taken to the local hospital by "120 emergency medical services" after a suicidal attempt. About 100 mL of barium chloride solution with a concentration of 100 g/L was ingested, while the actual amount of ingested barium chloride solution was unclear because of immediate vomiting after the ingestion. DIAGNOSES: About 2 hours after the suicidal ingestion, the patient was presented with somnolence, the pulse rate was 67 beats per minute, the blood pressure was 158/92 mm Hg, but he exhibited no nausea or vomiting. About 3 hours after the ingestion, the blood concentration of potassium was 1.5 mmol/L. INTERVENTIONS: The patient received gastric lavage by magnesium sulfate solution, intravenous sodium thiosulfate, and potassium supplementation. Other symptomatic treatments were applied simultaneously. To investigate the metabolism of barium in the human body, we measured the concentration of barium in 9 groups of paired serum and urine samples sequentially collected from the patient. OUTCOMES: The patient was rescued successfully. LESSONS: The serum concentration of barium decreased rapidly in the first 24 hours. In this period, prompt and massive potassium supplementation and other symptomatic treatments are effective and recommended.


Assuntos
Corpo Humano , Ideação Suicida , Adulto , Bário , Compostos de Bário , Cloretos , Ingestão de Alimentos , Humanos , Sulfato de Magnésio , Masculino , Potássio , Vômito/induzido quimicamente , Adulto Jovem
5.
Future Microbiol ; 17: 1217-1229, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36052743

RESUMO

Aim: Our main objectives were to compare the effects of Rejuveinix (RJX), dexamethasone (DEX) and their combination on the severity of sepsis and survival outcome in an animal model of fatal sepsis. Methods: We used the LPS plus D-galactosamine mouse model of sepsis to compare the anti-inflammatory activities of RJX, dexamethasone and a combination of RJX plus DEX. Additionally, we examined the clinical feasibility and tolerability of combining RJX with DEX in COVID-19 patients in a clinical phase I study. Data were analyzed using standard methods. Results & conclusion: RJX exhibited potent anti-inflammatory activity in the murine sepsis model. The combination of RJX plus DEX was more effective than either agent alone, decreased the inflammatory cytokine responses and associated organ damage, and improved the survival outcome in mice. In the phase I clinical study, RJX plus DEX was well tolerated by COVID-19 patients.


Assuntos
Anti-Inflamatórios , COVID-19 , Sepse , Animais , Anti-Inflamatórios/uso terapêutico , Ácido Ascórbico , COVID-19/tratamento farmacológico , Dexametasona/uso terapêutico , Modelos Animais de Doenças , Combinação de Medicamentos , Sulfato de Magnésio , Camundongos , Niacinamida , Ácido Pantotênico , Piridoxina , Riboflavina , Sepse/tratamento farmacológico , Tiamina
6.
Placenta ; 127: 29-36, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35940120

RESUMO

INTRODUCTION: Maternal inflammation may induce placental cytokine production resulting in fetal exposure, and development of neonatal neurologic injury. Maternal magnesium sulphate (MG) is used as neuroprotective in preventing white matter brain injury. We sought to determine whether maternal MG can prevent placental activation of inflammatory pathways associated with fetal injury. METHODS: Pregnant Sprague Dawley rats at gestational day 20 (E20) (n = 24) received injections of intraperitoneal lipopolysaccharide (LPS; 500 µg/kg) or saline (SAL) at time 0. Dams were randomized to treatment with subcutaneous saline or MG for 2 h prior to and 2 h following LPS/saline injections. Four hours following first injection rats were sacrificed. Placentas were collected from all treatment groups (LPS/SAL, LPS/MG, SAL/MG, SAL/SAL). Placental Caspase 3, NF-kB p65, neuronal nitric oxide synthase (phospho-nNos) interleukin (IL)-6 and tumor necrotic factor-α (TNF-α) protein levels were determined by western blot and compared. RESULTS: Maternal LPS at E20 significantly increased protein levels of placental caspase 3 (0.22 ± 0.01 vs. 0.12 ± 0.01 u), NFkB p65 (0.27 ± 0.01 vs. 0.10 ± 0.01 u), phospho-nNOS (0.20 ± 0.01 vs. 0.10 ± 0.01 u) as well as IL-6 and TNF-α compared to control. MG treatment to LPS dams significantly reduced all placental mediators to levels similar to SAL/SAL controls (p < 0.05). DISCUSSION: Maternal inflammation-induced fetal brain injury may be mediated via placental activation of inflammation, oxidative stress, and apoptotic pathways. The prevention of preterm brain injury could possibly intervene also via inhibition of one or more of these putative pathways.


Assuntos
Lesões Encefálicas , Sulfato de Magnésio , Animais , Apoptose , Lesões Encefálicas/metabolismo , Caspase 3/metabolismo , Feminino , Inflamação/metabolismo , Interleucina-6/metabolismo , Lipopolissacarídeos , Sulfato de Magnésio/farmacologia , Sulfato de Magnésio/uso terapêutico , Neuroproteção , Estresse Oxidativo , Placenta/metabolismo , Gravidez , Ratos , Ratos Sprague-Dawley , Fator de Necrose Tumoral alfa/metabolismo
7.
Cochrane Database Syst Rev ; 8: CD014978, 2022 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-35947046

RESUMO

BACKGROUND: Preterm birth is the leading cause of death in newborns and children. Tocolytic drugs aim to delay preterm birth by suppressing uterine contractions to allow time for administration of corticosteroids for fetal lung maturation, magnesium sulphate for neuroprotection, and transport to a facility with appropriate neonatal care facilities. However, there is still uncertainty about their effectiveness and safety. OBJECTIVES: To estimate relative effectiveness and safety profiles for different classes of tocolytic drugs for delaying preterm birth, and provide rankings of the available drugs. SEARCH METHODS: We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov (21 April 2021) and reference lists of retrieved studies. SELECTION CRITERIA: We included all randomised controlled trials assessing effectiveness or adverse effects of tocolytic drugs for delaying preterm birth. We excluded quasi- and non-randomised trials. We evaluated all studies against predefined criteria to judge their trustworthiness. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed the trials for inclusion and risk of bias, and extracted data. We performed pairwise and network meta-analyses, to determine the relative effects and rankings of all available tocolytics. We used GRADE to rate the certainty of the network meta-analysis effect estimates for each tocolytic versus placebo or no treatment. MAIN RESULTS: This network meta-analysis includes 122 trials (13,697 women) involving six tocolytic classes, combinations of tocolytics, and placebo or no treatment. Most trials included women with threatened preterm birth, singleton pregnancy, from 24 to 34 weeks of gestation. We judged 25 (20%) studies to be at low risk of bias. Overall, certainty in the evidence varied. Relative effects from network meta-analysis suggested that all tocolytics are probably effective in delaying preterm birth compared with placebo or no tocolytic treatment. Betamimetics are possibly effective in delaying preterm birth by 48 hours (risk ratio (RR) 1.12, 95% confidence interval (CI) 1.05 to 1.20; low-certainty evidence), and 7 days (RR 1.14, 95% CI 1.03 to 1.25; low-certainty evidence). COX inhibitors are possibly effective in delaying preterm birth by 48 hours (RR 1.11, 95% CI 1.01 to 1.23; low-certainty evidence). Calcium channel blockers are possibly effective in delaying preterm birth by 48 hours (RR 1.16, 95% CI 1.07 to 1.24; low-certainty evidence), probably effective in delaying preterm birth by 7 days (RR 1.15, 95% CI 1.04 to 1.27; moderate-certainty evidence), and prolong pregnancy by 5 days (0.1 more to 9.2 more; high-certainty evidence). Magnesium sulphate is probably effective in delaying preterm birth by 48 hours (RR 1.12, 95% CI 1.02 to 1.23; moderate-certainty evidence). Oxytocin receptor antagonists are probably effective in delaying preterm birth by 48 hours (RR 1.13, 95% CI 1.05 to 1.22; moderate-certainty evidence), are effective in delaying preterm birth by 7 days (RR 1.18, 95% CI 1.07 to 1.30; high-certainty evidence), and possibly prolong pregnancy by 10 days (95% CI 2.3 more to 16.7 more). Nitric oxide donors are probably effective in delaying preterm birth by 48 hours (RR 1.17, 95% CI 1.05 to 1.31; moderate-certainty evidence), and 7 days (RR 1.18, 95% CI 1.02 to 1.37; moderate-certainty evidence). Combinations of tocolytics are probably effective in delaying preterm birth by 48 hours (RR 1.17, 95% CI 1.07 to 1.27; moderate-certainty evidence), and 7 days (RR 1.19, 95% CI 1.05 to 1.34; moderate-certainty evidence). Nitric oxide donors ranked highest for delaying preterm birth by 48 hours and 7 days, and delay in birth (continuous outcome), followed by calcium channel blockers, oxytocin receptor antagonists and combinations of tocolytics. Betamimetics (RR 14.4, 95% CI 6.11 to 34.1; moderate-certainty evidence), calcium channel blockers (RR 2.96, 95% CI 1.23 to 7.11; moderate-certainty evidence), magnesium sulphate (RR 3.90, 95% CI 1.09 to 13.93; moderate-certainty evidence) and combinations of tocolytics (RR 6.87, 95% CI 2.08 to 22.7; low-certainty evidence) are probably more likely to result in cessation of treatment. Calcium channel blockers possibly reduce the risk of neurodevelopmental morbidity (RR 0.51, 95% CI 0.30 to 0.85; low-certainty evidence), and respiratory morbidity (RR 0.68, 95% CI 0.53 to 0.88; low-certainty evidence), and result in fewer neonates with birthweight less than 2000 g (RR 0.49, 95% CI 0.28 to 0.87; low-certainty evidence). Nitric oxide donors possibly result in neonates with higher birthweight (mean difference (MD) 425.53 g more, 95% CI 224.32 more to 626.74 more; low-certainty evidence), fewer neonates with birthweight less than 2500 g (RR 0.40, 95% CI 0.24 to 0.69; low-certainty evidence), and more advanced gestational age (MD 1.35 weeks more, 95% CI 0.37 more to 2.32 more; low-certainty evidence). Combinations of tocolytics possibly result in fewer neonates with birthweight less than 2500 g (RR 0.74, 95% CI 0.59 to 0.93; low-certainty evidence). In terms of maternal adverse effects, betamimetics probably cause dyspnoea (RR 12.09, 95% CI 4.66 to 31.39; moderate-certainty evidence), palpitations (RR 7.39, 95% CI 3.83 to 14.24; moderate-certainty evidence), vomiting (RR 1.91, 95% CI 1.25 to 2.91; moderate-certainty evidence), possibly headache (RR 1.91, 95% CI 1.07 to 3.42; low-certainty evidence) and tachycardia (RR 3.01, 95% CI 1.17 to 7.71; low-certainty evidence) compared with placebo or no treatment. COX inhibitors possibly cause vomiting (RR 2.54, 95% CI 1.18 to 5.48; low-certainty evidence). Calcium channel blockers (RR 2.59, 95% CI 1.39 to 4.83; low-certainty evidence), and nitric oxide donors probably cause headache (RR 4.20, 95% CI 2.13 to 8.25; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Compared with placebo or no tocolytic treatment, all tocolytic drug classes that we assessed (betamimetics, calcium channel blockers, magnesium sulphate, oxytocin receptor antagonists, nitric oxide donors) and their combinations were probably or possibly effective in delaying preterm birth for 48 hours, and 7 days. Tocolytic drugs were associated with a range of adverse effects (from minor to potentially severe) compared with placebo or no tocolytic treatment, although betamimetics and combination tocolytics were more likely to result in cessation of treatment. The effects of tocolytic use on neonatal outcomes such as neonatal and perinatal mortality, and on safety outcomes such as maternal and neonatal infection were uncertain.


Assuntos
Nascimento Prematuro , Tocolíticos , Agonistas Adrenérgicos beta , Peso ao Nascer , Bloqueadores dos Canais de Cálcio/uso terapêutico , Criança , Feminino , Cefaleia , Humanos , Recém-Nascido , Sulfato de Magnésio/uso terapêutico , Metanálise em Rede , Doadores de Óxido Nítrico/uso terapêutico , Gravidez , Nascimento Prematuro/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Receptores de Ocitocina , Tocolíticos/efeitos adversos , Tocolíticos/uso terapêutico , Vômito/tratamento farmacológico
8.
PLoS Med ; 19(8): e1004074, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35998205

RESUMO

BACKGROUND: Preterm birth-related complications are the leading cause of death in newborns and children under 5. Health outcomes of preterm newborns can be improved with appropriate use of antenatal corticosteroids (ACSs) to promote fetal lung maturity, tocolytics to delay birth, magnesium sulphate for fetal neuroprotection, and antibiotics for preterm prelabour rupture of membranes. However, there are wide disparities in the rate and consistency in the use of these interventions across settings, which may underlie the differential health outcomes among preterm newborns. We aimed to assess factors (barriers and facilitators) affecting the appropriate use of ACS, tocolytics, magnesium sulphate, and antibiotics to improve preterm birth management. METHODS AND FINDINGS: We conducted a mixed-methods systematic review including primary qualitative, quantitative, and mixed-methods studies. We searched MEDLINE, EMBASE, CINAHL, Global Health, and grey literature from inception to 16 May 2022. Eligible studies explored perspectives of women, partners, or community members who experienced preterm birth or were at risk of preterm birth and/or received any of the 4 interventions, health workers providing maternity and newborn care, and other stakeholders involved in maternal care (e.g., facility managers, policymakers). We used an iterative narrative synthesis approach to analysis, assessed methodological limitations using the Mixed Methods Appraisal Tool, and assessed confidence in each qualitative review finding using the GRADE-CERQual approach. Behaviour change models (Theoretical Domains Framework; Capability, Opportunity, and Motivation (COM-B)) were used to map barriers and facilitators affecting appropriate use of these interventions. We included 46 studies from 32 countries, describing factors affecting use of ACS (32/46 studies), tocolytics (13/46 studies), magnesium sulphate (9/46 studies), and antibiotics (5/46 studies). We identified a range of barriers influencing appropriate use of the 4 interventions globally, which include the following: inaccurate gestational age assessment, inconsistent guidelines, varied knowledge, perceived risks and benefits, perceived uncertainties and constraints in administration, confusion around prescribing and administering authority, and inadequate stock, human resources, and labour and newborn care. Women reported hesitancy in accepting interventions, as they typically learned about them during emergencies. Most included studies were from high-income countries (37/46 studies), which may affect the transferability of these findings to low- or middle-income settings. CONCLUSIONS: In this study, we identified critical factors affecting implementation of 4 interventions to improve preterm birth management globally. Policymakers and implementers can consider these barriers and facilitators when formulating policies and planning implementation or scale-up of these interventions. Study findings can inform clinical preterm birth guidelines and implementation to ensure that barriers are addressed, and enablers are reinforced to ensure these interventions are widely available and appropriately used globally.


Assuntos
Nascimento Prematuro , Tocolíticos , Antibacterianos , Feminino , Humanos , Recém-Nascido , Sulfato de Magnésio/uso terapêutico , Parto , Gravidez , Nascimento Prematuro/prevenção & controle
9.
BMC Anesthesiol ; 22(1): 254, 2022 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-35941548

RESUMO

BACKGROUND: We aimed to investigate the effect of transforaminal injection of Magnesium sulphate versus Ozone on pain intensity, functional disability and the oxidative stress biomarkers; superoxide dismutase (SOD) and Glutathione (GSH) in patients with lumbar disc prolapse. METHODS: This randomized controlled trial was conducted on 135 patients having symptomatic lumbar disc prolapse, received either transforaminal injection of Magnesium sulphate with steroids, Ozone with steroids, or steroids alone. Assessment of pain severity and functional disability were done before intervention, 2 weeks, 1, 3, and 6 months after intervention. Serum SOD and GSH were measured for all included patients before and 2 weeks after intervention. RESULTS: There was a statistically significant improvement in pain intensity and functional disability 2 weeks after intervention in the three groups, but at 1-month and 3-months after intervention, the significant improvement was in Mg sulphate and Ozone groups only. At 6-months follow up, Mg sulphate group only showed a significant improvement. There was a statistically significant increase in SOD and GSH serum levels, 2-weeks after intervention in both Magnesium sulphate (P-value = 0.002, 0.005 respectively) and ozone groups (P-value < 0.001, < 0.001), but there was no statistically significant change in SOD and GSH serum levels in control group. CONCLUSION: Transforaminal injection of Mg sulphate in patients with lumbar disc prolapse causes significant long-term improvement (up to 6 months) in pain intensity and functional disability. The serum levels of SOD and GSH were significantly increased at 2 weeks following both transforaminal injection of Mg sulphate and ozone.


Assuntos
Deslocamento do Disco Intervertebral , Ozônio , Biomarcadores , Humanos , Injeções Epidurais , Deslocamento do Disco Intervertebral/complicações , Deslocamento do Disco Intervertebral/tratamento farmacológico , Vértebras Lombares , Sulfato de Magnésio/uso terapêutico , Estresse Oxidativo , Ozônio/uso terapêutico , Dor/tratamento farmacológico , Dor/etiologia , Prolapso , Esteroides/uso terapêutico , Superóxido Dismutase , Resultado do Tratamento
10.
J Trop Pediatr ; 68(5)2022 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-35984380

RESUMO

BACKGROUND: There is inconclusive evidence on the role of nebulized magnesium sulphate (MgSO4) in the management of acute asthma in paediatric population. OBJECTIVES: Whether the use of nebulized salbutamol with or without MgSO4 in the management of acute asthma results in clinically significant improvement in lung function in Indian children? The primary outcome measure was to assess improvements in peak expiratory flow rate (PEFR), heart rate, respiratory rate and SpO2. METHODS: This was a single centre; prospective double-blind randomized control trial conducted in paediatric intensive care unit of a tertiary care centre. Ninety children of 6-14 years with acute exacerbations of bronchial asthma were enrolled to receive either inhaled magnesium sulphate (95 mg) with salbutamol (5 mg) or inhaled salbutamol (5 mg) alone. All patients got three nebulizations done during the first hour at 20 min intervals, two nebulizations during the second hour at 30 min intervals, hourly for the next 2 h and then at 24 and 48 h. RESULTS: Eighty-five patients were finally analysed as per protocol analysis. The trial showed that PEFR increased gradually in both groups over the study duration, but it was statistically not significant. Heart rate decreased significantly in both groups over the study duration. Respiratory rate decreased significantly between the groups at 24 and 48 h only. SpO2 improved too in both groups but was not significant statistically. CONCLUSION: The addition of nebulized MgSO4 to salbutamol does not seem to result in improvement in lung function in the management of acute asthma in Indian children.


Assuntos
Albuterol , Asma , Doença Aguda , Administração por Inalação , Albuterol/uso terapêutico , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Criança , Método Duplo-Cego , Humanos , Índia , Sulfato de Magnésio/uso terapêutico , Estudos Prospectivos
11.
Medicina (Kaunas) ; 58(8)2022 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-36013512

RESUMO

Background and Objectives: Shivering is a common complication of subarachnoid block (SAB). Magnesium sulphate has been proven to be effective in preventing shivering. The aim of this study was to compare the effectiveness and adverse effects in hemodynamic parameters between 50 mg/kg and 30 mg/kg of intravenous magnesium sulphate for prevention of shivering post-subarachnoid block. Materials and Methods: Eighty-six patients scheduled for surgery under SAB, aged between 18 to 65 years old with American Society of Anesthesiologists physical status I and II were randomised into two groups. Group A received a bolus of 50 mg/kg, while Group B received 30 mg/kg of intravenous magnesium sulphate, given over a 20 min duration following SAB. Shivering grade was recorded intraoperatively according to the Crossley and Mahajan shivering scale. Mean arterial pressure (MAP), heart rate, tympanic temperature, oxygen saturation and the use of vasopressors were recorded. Results: Forty-five percent of patients in Group A and 20% of patients in Group B did not exhibit shivering (p-value < 0.01). High-grade shivering was observed in 12.5% in Group A and 40% in Group B, respectively (p-value 0.02). The MAP trend was lower in Group B (p-value < 0.01), but the incidence of hypotension was not significant in both groups. The use of vasopressors was also similar between groups. Group B showed a lower oxygen saturation trend (p-value 0.04). The trends of heart rate and tympanic temperature were not significant in both groups. No patients had episodes of bradycardia or oxygen desaturation. Conclusions: In this study, intravenous magnesium sulphate 50 mg/kg is the lowest effective dose for prevention and treatment of high-grade shivering post-SAB without significant hemodynamic adverse events.


Assuntos
Raquianestesia , Tremor por Sensação de Frio , Administração Intravenosa , Adolescente , Adulto , Idoso , Raquianestesia/efeitos adversos , Humanos , Sulfato de Magnésio/farmacologia , Sulfato de Magnésio/uso terapêutico , Pessoa de Meia-Idade , Adulto Jovem
12.
Pain Physician ; 25(5): 365-372, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35901476

RESUMO

BACKGROUND: The best tool for management of postherpetic neuralgia (PHN) is a matter of debate. The use of ultrasound-guided erector spinae plane block (ESPB) in patients with PHN may decrease pain severity and the need for analgesics. OBJECTIVES: The objective of this clinical study was to test the efficacy of ESPB with and without the addition of magnesium sulphate on pain control and analgesic consumption in patients with PHN. STUDY DESIGN: Randomized controlled double-blinded trial. SETTING: A single university center. METHODS: A total of 75 patients with PHN were included in the study. Patients were randomly divided into 3 equal groups. Group A received sham ESPB (2 mL normal saline), Group B received ESPB with 20 mL of bupivacaine (0.25%), and Group C received ESPB with 20 mL of bupivacaine (0.25%) and 100 mg magnesium sulphate. All patients received standard medical care. The pain score, the consumption of pregabalin and acetaminophen, the incidence of complications, and the patient's satisfaction were measured and recorded. RESULTS: In comparison to the control group, the use of real ESPB with or without the addition of magnesium significantly decreased the Numeric Rating Scale score for pain during the first week of follow-up (P < 0.05); decreased the mean daily consumption of pregabalin and acetaminophen from the third to the twelfth week of follow-up (P < 0.05); and increased the level of patients' satisfaction (P = 0.03). The addition of magnesium sulphate showed an insignificant difference in comparison to the use of bupivacaine alone in ESPB (P ? 0.05). LIMITATIONS: The study was limited by being a singlecenter study, using a single-level injection, and using a single volume of local anesthetic mixture. CONCLUSION: ESPB with or without adding magnesium sulphate is an effective pain management tool for cases of PHN. It leads to a significant decrease in pain score and analgesic requirements.


Assuntos
Bloqueio Nervoso , Neuralgia Pós-Herpética , Acetaminofen , Analgésicos , Bupivacaína/uso terapêutico , Humanos , Magnésio , Sulfato de Magnésio/uso terapêutico , Neuralgia Pós-Herpética/tratamento farmacológico , Dor Pós-Operatória , Pregabalina
13.
Chem Biol Interact ; 364: 110061, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-35872047

RESUMO

Exposure to highly toxic organophosphorus compounds causes inhibition of the enzyme acetylcholinesterase resulting in a cholinergic toxidrome and innervation of receptors in the neuromuscular junction may cause life-threatening respiratory effects. The involvement of several receptor systems was therefore examined for their impact on bronchoconstriction using an ex vivo rat precision-cut lung slice (PCLS) model. The ability to recover airways with therapeutics following nerve agent exposure was determined by quantitative analyses of muscle contraction. PCLS exposed to nicotine resulted in a dose-dependent bronchoconstriction. The neuromuscular nicotinic antagonist tubocurarine counteracted the nicotine-induced bronchoconstriction but not the ganglion blocker mecamylamine or the common muscarinic antagonist atropine. Correspondingly, atropine demonstrated a significant airway relaxation following ACh-exposure while tubocurarine did not. Atropine, the M3 muscarinic receptor antagonist 4-DAMP, tubocurarine, the ß2-adrenergic receptor agonist formoterol, the Na+-channel blocker tetrodotoxin and the K+ATP-channel opener cromakalim all significantly decreased airway contractions induced by electric field stimulation. Following VX-exposure, treatment with atropine and the Ca2+-channel blocker magnesium sulfate resulted in significant airway relaxation. Formoterol, cromakalim and magnesium sulfate administered in combinations with atropine demonstrated an additive effect. In conclusion, the present study demonstrated improved airway function following nerve agent exposure by adjunct treatment to the standard therapy of atropine.


Assuntos
Broncoconstrição , Agentes Neurotóxicos , Acetilcolinesterase , Animais , Atropina/farmacologia , Cromakalim/farmacologia , Estimulação Elétrica , Fumarato de Formoterol/farmacologia , Sulfato de Magnésio/farmacologia , Antagonistas Muscarínicos/farmacologia , Contração Muscular , Agentes Neurotóxicos/farmacologia , Nicotina/farmacologia , Ratos , Tubocurarina/farmacologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-35843914

RESUMO

Background: Multimodal anesthesia represents a technique that can improve analgesia and lower the occurrence of opioid side effects in the postoperative period, such as postoperative nausea and vomiting (PONV). It can be achieved by providing different types of medication during the intraoperative period which can decrease the need for opioids. PONV happens more often in patients who have received large amounts of opioids during laparoscopic cholecystectomy. In this study, our aim was to observe the occurrence of PONV between three different groups of patients who received lidocaine, ketamine and magnesium sulfate in combination with fentanyl in the intraoperative period. We also observed any additional nausea and vomiting in the three groups as well as the amount of fentanyl given to these groups during operation. Materials and methods: 120 patients aged 20-65 years old were included in this randomized and prospective study, ASA classification 1 and 2, scheduled for laparoscopic cholecystectomy. Patients were classified into three groups randomly: Group 1 (lidocaine group-LG), these patients received lidocaine at 1 mg/kg during induction to general anesthesia and 2 mg/kg/h after intubation in continuous intravenous infusion; Group 2 (ketamine group-KG) these patients received ketamine at 0.5 mg/kg during induction to general anesthesia; and Group 3 (magnesium group-MG) these patients received magnesium sulfate at 1.5 gr/hr as a continuous intravenous infusion after intubation. In all three groups, patients additionally received bolus doses of fentanyl. Postoperative nausea and vomiting were monitored in all three groups at 1, 4, 8, 12, and 24 hours after surgery as a primary objective, and if patients had complainant of vomiting, they were treated with 10 mg of metoclopramid. Between the five control time points, additional nausea and vomiting was recorded as well, as a secondary objective. The third objective was to measure of the total amount of fentanyl given in the intraoperative period. Results: Patients from the lidocaine group experienced less PONV and they received less fentanyl compared to patients of ketamine and magnesium groups. Patients from the ketamine group had more nausea than other groups. In the magnesium group, the rate of vomiting was higher, and they received higher amounts of fentanyl during surgery. Additional nausea and vomiting occurred in 3 patients in the LG, 2 in the KG, and 3 in the MG between the five control time points. The patients from the magnesium group received the highest dose of fentanyl during surgery (307.50 ± 130.4), followed by the patients from the ketamine group (292.50 ± 60.5), and then patients from the lidocaine group (258.75 ± 60.9). The doses of fentanyl that patients received during surgery in all three groups were not statistically significant. Conclusion: Multimodal anesthesia has been shown to lower PONV 24 hours after laparoscopic cholecystectomy and can lower need for opioids during laparoscopic cholecystectomy.


Assuntos
Anestesia , Colecistectomia Laparoscópica , Ketamina , Adulto , Idoso , Analgésicos Opioides/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colecistectomia Laparoscópica/métodos , Método Duplo-Cego , Fentanila/efeitos adversos , Humanos , Ketamina/efeitos adversos , Lidocaína/efeitos adversos , Magnésio/uso terapêutico , Sulfato de Magnésio/uso terapêutico , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Náusea e Vômito Pós-Operatórios/induzido quimicamente , Náusea e Vômito Pós-Operatórios/etiologia , Estudos Prospectivos , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-35843915

RESUMO

Background: The administration of high doses of opioids during surgery can lead to higher postoperative pain scores at rest and when coughing. Multimodal analgesia may lower the need for opioids during surgery and the suffering of postoperative pain. Multimodal analgesia can be achieved by providing non-opioid drugs (lidocaine, ketamine, and magnesium sulfate), three different types of drugs. Each of these drugs as different analgesic effects and they belong to three different pharmacological groups. The aim of this study is to develop a better understanding of the effects of each drug (lidocaine, ketamine, and magnesium sulfate) on postoperative analgesia, the needs for rescue analgesics, and analyze the total amount of fentanyl during the intraoperative period in patients undergoing laparoscopic cholecystectomy. Methods: 120 patients were enrolled in this randomized controlled study. They were classified as ASA 1 and 2 and were scheduled for laparoscopic cholecystectomy. They were further divided into 3 groups. Group 1, or the lidocaine group, had received lidocaine at 1 mg/kg and a continuous intravenous infusion with lidocaine at 2 mg/kg/h. Group 2, or the ketamine group, received ketamine at 0.5 mg/kg. Group 3, or the magnesium sulfate group, received a continuous intravenous infusion of magnesium sulfate at 1.5 gr/kg. The intensity of postoperative pain was assessed using a VAS score at rest and when coughing, with evaluation at 1, 4, 8, 12, and 24 hours, postoperatively. Also, the needs for rescue analgesics and the total amount of fentanyl during the intraoperative period in all groups was also followed. Results: The patients from the lidocaine group had the highest scores of pain in the postoperative period at rest and when coughing, and the ketamine group had the lowest pain scores. Rescue analgesia was given the most to lidocaine group, and less so in the magnesium group. The magnesium group received the highest dose of fentanyl during surgery and the lowest dose was received by patients from the lidocaine group. Conclusion: Multimodal analgesia can lower the need for opioids in the intra- and postoperative period after laparoscopic cholecystectomy.


Assuntos
Analgesia , Colecistectomia Laparoscópica , Ketamina , Analgésicos/efeitos adversos , Analgésicos Opioides/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Método Duplo-Cego , Fentanila/efeitos adversos , Humanos , Ketamina/efeitos adversos , Lidocaína/efeitos adversos , Magnésio/uso terapêutico , Sulfato de Magnésio/efeitos adversos , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia
17.
Comput Intell Neurosci ; 2022: 9789066, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35898773

RESUMO

Aims: This study is designed to explore the effect of compound Danshen injection combined with magnesium sulfate on TNF-α, NO, oxidative stress, and therapeutic efficacy in severe preeclampsia (S-PE). Methods: Sixty S-PE patients were placed into the control group and the therapy group, randomly. The control group was under the treatment of magnesium sulfate, and the therapy group was under the treatment of compound Danshen injection with magnesium sulfate. After treatment, the therapeutic efficacy of the two groups was comparatively analyzed. Results: 7 days after treatment, DBP, SBP, and 24 h urinary protein were sharply lower than those before treatment. The 24 h urinary protein was notably lower in the therapy group. After treatment, the expression level of TNF-α in both groups was notably higher than before treatment, while NO level was higher than that before treatment. Furthermore, D-D level in two groups was dramatically decreased compared to that before treatment. Moreover, Fib, PT, and APTT in two groups showed statistically significant differences after 7 days. The contents of ALT, AST, BUN, and Scr in therapy group were notably lower than those in control group. Conclusion: Our results indicated that compound Danshen injection could improve renal function, blood hypercoagulability, and oxidative stress level and had a better therapeutic effect on S-PE.


Assuntos
Pré-Eclâmpsia , Salvia miltiorrhiza , Feminino , Humanos , Sulfato de Magnésio/uso terapêutico , Estresse Oxidativo , Pré-Eclâmpsia/tratamento farmacológico , Gravidez , Fator de Necrose Tumoral alfa/uso terapêutico
18.
Pregnancy Hypertens ; 29: 46-53, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35728369

RESUMO

OBJECTIVE: This study compared the modulatory effect of two intravenous magnesium sulfate (MgSO4) regimens on the systemic inflammatory response in pregnant women diagnosed with imminent eclampsia. STUDY DESIGN: In a single-blind cross-sectional study, 33 women were allocated according to the Zuspan (n = 16) and Sibai (n = 17) MgSO4 regimens, and treated for 24 h. Blood samples were collected pre-administration of the loading dose, at 24 h of the maintenance dose of MgSO4, and at 48 h, when patients were without treatment. Plasma was used to determine interleukin (IL)-1 beta (IL-1ß), IL-6, IL-10, tumor necrosis factor-alpha (TNF-α), heat shock protein (Hsp70), and heme oxygenase-1 (HO-1) by ELISA. RESULTS: The treatment with the Zuspan's regimen didn't change plasma concentrations of TNF-α, IL-10, and Hsp70 in the three-time points studied. However, it decreased IL-1ß at 24 h and 48 h and IL-6 at 48 h, and increased HO-1 concentration at 48 h. On the other hand, compared to the pre-treatment period, Sibai's regimen induced a significant decrease in TNF-α, IL-1ß, IL-6, and Hsp70, while increased HO-1 levels both at 24 h and 48 h and, IL-10 concentration at 48 h. CONCLUSIONS: Sibai's regimen determined an early and efficient immunoregulatory effect on systemic inflammatory response in preeclampsia, suggesting that the maintenance dose of two grams of MgSO4 was better than one gram in the treatment of imminent eclampsia.


Assuntos
Eclampsia , Sulfato de Magnésio , Síndrome de Resposta Inflamatória Sistêmica , Estudos Transversais , Eclampsia/tratamento farmacológico , Feminino , Humanos , Interleucina-10 , Interleucina-6 , Sulfato de Magnésio/uso terapêutico , Pré-Eclâmpsia/tratamento farmacológico , Gravidez , Gestantes , Método Simples-Cego , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Fator de Necrose Tumoral alfa
19.
Am J Obstet Gynecol ; 227(3): 521.e1-521.e8, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35697094

RESUMO

BACKGROUND: Severe hypertension remains one of the leading preventable causes of maternal mortality in the United States. Timeliness to response to severe hypertension in pregnancy is a crucial quality indicator tracked by state and national organizations. We hypothesized that the implementation of the Maternal-Fetal Triage Index, a validated acuity tool, would improve care performance in women with severe hypertension in an urban, inner-city hospital setting. OBJECTIVE: This study aimed to assess the impact of the Maternal-Fetal Triage Index on the management of women presenting with severe preeclampsia diagnosed by severe hypertension as measured by time to provider assessment, administration of magnesium sulfate, and immediate administration of acute antihypertensives. STUDY DESIGN: This was a prospective, observational study of pregnant women presenting to the labor and delivery triage unit with severe preeclampsia diagnosed by severe hypertension giving birth at a large urban inner-city academic facility before (epoch 1: January 1, 2019, to December 31, 2019) and after (epoch 2: March 1, 2021, to September 31, 2021) the implementation of the Maternal-Fetal Triage Index. Baseline outcomes of time to assessment, time to magnesium sulfate prophylaxis, and time to antihypertensive medication administration before the implementation of the Maternal-Fetal Triage Index were assessed. The Maternal-Fetal Triage Index tool was implemented on March 1, 2021, following standardized education in 2020 for all triage nurses, unit technicians, healthcare unit coordinators, and healthcare providers. Time to assessment, administration of magnesium sulfate prophylaxis, and time to antihypertensive administration after the implementation of the Maternal-Fetal Triage Index were compared with measures before the implementation of the Maternal-Fetal Triage Index. Statistical analysis included Wilcoxon rank-sum test with P<.05 considered significant when comparing epoch 1 with epoch 2. RESULTS: A total of 370 patients were admitted with severe hypertension in 2019 before the use of the Maternal-Fetal Triage Index, and 254 patients were admitted with severe hypertension in 2021 after the implementation of the Maternal-Fetal Triage Index. There was no difference between epochs across baseline characteristics, including age, race and ethnicity, parity, and body mass index. After the Maternal-Fetal Triage Index was implemented, the time to provider assessment was significantly improved, from a median time of 44 minutes (interquartile range, 0-65) in epoch 1 to 17 minutes (interquartile range, 0-39) in epoch 2 (P<.001). Furthermore, the time from arrival to magnesium sulfate prophylaxis was significantly faster with a median time of 161 minutes (interquartile range, 109-256) in epoch 1 vs 127 minutes (interquartile range, 85-258) in epoch 2 (P=.001). Moreover, there was a decrease in the time from arrival to antihypertensive medication administration for severe blood pressures after the implementation of the Maternal-Fetal Triage Index (101 minutes [interquartile range, 61-177] vs 66 minutes [interquartile range, 35-203]; P<.001). CONCLUSION: The implementation of the Maternal-Fetal Triage Index at a large urban inner-city hospital was associated with improved timeliness of assessment and treatment of women with severe hypertension. The Maternal-Fetal Triage Index is a viable tool to improve the efficiency in triage units, specifically in the management of severe hypertension.


Assuntos
Hipertensão Induzida pela Gravidez , Pré-Eclâmpsia , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Hipertensão Induzida pela Gravidez/diagnóstico , Hipertensão Induzida pela Gravidez/tratamento farmacológico , Sulfato de Magnésio/uso terapêutico , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/tratamento farmacológico , Pré-Eclâmpsia/prevenção & controle , Gravidez , Estudos Prospectivos , Triagem
20.
Dev Neurosci ; 44(4-5): 412-425, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35705018

RESUMO

The Beneficial Effects of Antenatal Magnesium clinical trial was conducted between 1997 and 2007, and demonstrated a significant reduction in cerebral palsy (CP) in preterm infants who were exposed to peripartum magnesium sulfate (MgSO4). However, the mechanism by which MgSO4 confers neuroprotection remains incompletely understood. Cord blood samples from this study were interrogated during an era when next-generation sequencing was not widely accessible and few gene expression differences or biomarkers were identified between treatment groups. Our goal was to use bulk RNA deep sequencing to identify differentially expressed genes comparing the following four groups: newborns who ultimately developed CP treated with MgSO4 or placebo, and controls (newborns who ultimately did not develop CP) treated with MgSO4 or placebo. Those who died after birth were excluded. We found that MgSO4 upregulated expression of SCN5A only in the control group, with no change in gene expression in cord blood of newborns who ultimately developed CP. Regardless of MgSO4 exposure, expression of NPBWR1 and FTO was upregulated in cord blood of newborns who ultimately developed CP compared with controls. These data support that MgSO4 may not exert its neuroprotective effect through changes in gene expression. Moreover, NPBWR1 and FTO may be useful as biomarkers and may suggest new mechanistic pathways to pursue in understanding the pathogenesis of CP. The small number of cases ultimately available for this secondary analysis, with male predominance and mild CP phenotype, is a limitation of the study. In addition, differentially expressed genes were not validated by qRT-PCR.


Assuntos
Paralisia Cerebral , Fármacos Neuroprotetores , Dioxigenase FTO Dependente de alfa-Cetoglutarato/metabolismo , Biomarcadores/metabolismo , Paralisia Cerebral/tratamento farmacológico , Feminino , Sangue Fetal/metabolismo , Expressão Gênica , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Magnésio/metabolismo , Sulfato de Magnésio/farmacologia , Sulfato de Magnésio/uso terapêutico , Masculino , Fármacos Neuroprotetores/uso terapêutico , Gravidez
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