A Comparative Study of Efficacy of Clonidine and Dexmedetomidine As An Adjuvant to Ropivacaine in Ultrasound Guided Supraclavicular Brachial Plexus Block Vis-À-Vis Onset of Surgical Anaesthesia and Duration of Effect in Upper Limb Surgeries

Background: Supraclavicular block is a safe, reliable and cost effective technique of providing anesthesia for the upper limb surgeries. Objectives: To evaluate the effect of Clonidine and Dexmedetomidine as an adjuvant to Ropivacaine in ultrasound guided supraclavicular block in upper limb surgeries with respect to: Onset of sensory and motor block, Duration of sensory and motor block, Quality of block and Duration of post-operative analgesia. Materials and methods: The purpose of present study was to compare the effect of addition of clonidine 1mcg/kg vs dexmedetomidine 1mcg/kg to 20ml of 0.5% ropivacaine in ultrasound guided supraclavicular brachial plexus block. A total of 90 patients of ASA I and II, aged 18-60 years, of either gender, undergoing upper limb surgery were allocated to three groups. Each group consisted of 30 patients. They received drugs as under: Group-A (dexmedetomidine group) received 20ml of 0.5% ropivacaine plus 1μg/kg of dexmedetomidine. Group-B (clonidine group) received 20ml of 0.5% ropivacaine plus 1mcg/kg clonidine. Group-C (placebo group) received 20 ml of 0.5% ropivacaine plus 2 ml normal saline. Results: Onset of sensory block was faster in Group-A as compared to Group-B and Group-C. The difference was statistically significant (p-value<0.05). Onset of motor block was faster in Group-A as compared to Group-B and Group C. The difference was statistically significant (p-value<0.05). Patients of Group-A had significantly longer duration of sensory and motor block when compared with Group-B and Group-C (p-value<0.05). Duration of post-operative analgesia was significantly longer in Group-A as compared to Group-B and Group-C (p-value<0.05). Quality of block was significantly better in Group-A as compared to Group-B and Group-C (p-value<0.05). Conclusion: Dexmedetomidine prolongs the duration of sensory and motor block, duration of postoperative analgesia and improves the quality of block much more as compared to clonidine when used as an adjuvant to ropivacaine in supraclavicular brachial plexus block.

Effect of Cadmium Exposure on Zinc Levels in Normal Non-Diabetic and Diabetic Rats Induced by Streptozotocin

Diabetic rats induced by streptozotocin and normal non-diabetic rats were exposed to cadmiumsulphate in drinking water at a dose of 200 mg / L for 30 days. At the end of the exposure, theblood, kidney and pancreas of each rat were taken for the determination of cadmium and zinc.The results show a significant increase in the level of cadmium in the blood, kidney andpancreas of normal non-diabetic rats and diabetic rats compared to the control group. Thecadmium concentration was significantly higher in plasma and tissues in diabetic rats comparedto normal non-diabetic rats. Cadmium poisoning resulted in a significant decrease in the levelof zinc in the blood and tissues of normal non-diabetic rats and diabetic rats compared to theirrespective controls. This study reveals that diabetic rats induced by streptozotocin are moresensitive to the toxic effects of cadmium than normal rats.Key words: Cadmium, zinc, plasma, pancreas, kidneys, diabetes

A Review for Artificial Intelligence Proving to Fight Against COVID-19 Pandemic and Prefatory Health Policy

The aim of the present study is to discuss the various aspects of modern technology used to fight against COVID-19 outbreak crisis at different scales, including medical image processing, disease tracking, prediction outcomes, computational biology and medicines. A progressive search of the database related to modern technology towards COVID-19 pandemic is made. Further, a brief review is done on the extracted information by assessing the various aspects of modern technologies for tackling COVID-19 pandemic. We provide a window of thoughts on review of the technology advances used to decrease and smother the substantial impact of the outburst. However, there are still constrained applications and contributions of technology in this fight although different studies relating to modern technology towards COVID-19 pandemic have come up yet. The modern technology on-going progress has contributed in improving people’s lives. Hence, there is a solid conviction that validated research plans including artificial intelligence will be of significant advantage in helping people to fight this infection. Key words: COVID-19 pandemic, artificial intelligence (AI), molecular modeling, drug repurposing, vaccines, health infrastructure systems (HIS)

Prevalence, Knowledge, Practice and Perception of Self Medication among Pharmacy Students in a Nigerian tertiary Institution

The practice of self-medication has become a form of self-care and is a global trend that is encouraged when it deals with minor illnesses and with proper guide and information. In countries where there are no strict regulations and prescription drugs are freely dispensed, irresponsible self-medication is common. This study aimed to assess the prevalence, knowledge, practice and perception of self-medication among pharmacy students in University of Port Harcourt. The study included all pharmacy students from 200L to 500L who gave their consent to participate. Ethical approval was obtained from the University Ethics and Research Committee. Descriptive cross sectional study design was adopted. Pre-tested structured questionnaire was used to collect the required data. The questionnaire was structured in four parts: demographic; knowledge; practice and perception sections.A total of 476 pharmacy students responded and gave their consent to the study. 42.4% (202) were male and 57.6% (274) were female. The mean age of the population was 24.55±5.32years. Most of the respondents, 49.2% (234), were within the age of 20 – 25years, while 4.4% (21) were more than 30years. Most, 94.7% (451) were single. 37% were in 200L, 22.9% (109) in 400L, and 18.9% (90) in 500L. Prevalence rate of self-medication among these students was 83.8%. A significant (p>0.05) percentage, 69.8% (327) showed good knowledge of self-medication and agreed to the need to consult health professional before consuming medicines, and yet a good number, 51.4% (245) often practice self- medication. The most common source of information for their self-medication was textbooks/class materials, 31.1% (148). The respondents showed positive perception towards self- medication as many, 40.3% (192) claimed that self –medication is right /safe and should be encouraged. Knowledge about the medicine used (91.8%) (437)was the commonest reason for self –medication, while analgesic/antipyretic (91.6%) (436) was the commonest class of medicines used for self-medication. The next common class of medicine was antibiotics, (84.7%) (403) and herbal remedy was the least, 15.5% (74). Fever, 83.6% (398), headache 80.5% (383), were the most common ailment treated by self-medication. Dependence on textbooks/class materials as information source increases significantly (p>0.05) with increase in years of study. In conclusion self- medication is highly prevalent among the pharmacy students evaluated. There is need to steer these students towards responsible self- medication especially towards antibiotics stewardship.

Transverses Abdominis Plane Block Versus Trocar Site Infiltration in Gynecologic Laparoscopy An Observational Study

Background and Aims: Laparoscopic surgery is nowadays gold standard procedure undertaken for various surgical procedures and people prefer laparoscopic approach but the effective analgesic regimen for such patients has not been devised and anaesthesiologists prefer multimodal regimes. Despite the minimally invasive nature of this procedure, patients experience a considerable amount of pain in the first 24 h postoperatively. In our study, we are comparing the degrees of pain relief with TAP block vs Trocar site infiltration using VAS, the duration of postoperative analgesia achieve by TAP block and compare it with Trocar site infiltration and total consumption of rescue analgesia consumed in first 24 hours postoperatively in patients undergoing gynaecologic Laparoscopic surgeries. Methods: After obtaining approval from the hospital Ethical committee and written informed consent from patients, this observational study was undertaken at the Government Lalla Ded Hospital which is one of the associated hospitals of Government Medical College, Srinagar during routine hours on 100 patients posted for elective Gynecological Laparoscopic surgery under general anesthesia. A total sample size of 100 patients (n= 50) for each group was calculated using PASSE (power and sample estimation) for study design and analysis. Assuming 30% improvement in pain score with error of 0.05 (i.e. 5% of DOF (degree of freedom). Results: Visual analogue scale at different time intervals were statistically significantly lower at all times in Group A than Group B p-value (p<0.05). The time to first request for analgesia was higher in group A as compared to group B with statistical difference among the study groups p-value (p<0.05). Conclusion: As a promising novel post-operative pain treatment procedure, TAP block is cost effective and one of the safest, easiest and the most effective supplemental techniques as part of analgesic regimen. It improves pain scores in gynecologic laparoscopy.

Comparative Characteristics of The Effects of Drug and Mechanical Reperfusion in The Treatment of Acute Coronary Syndrome with ST Elevation in Patients Working in Environmentally Challenging Conditions

Studied clinical and hemodynamic efficacy of complex use heparin,Сyто-Mас, propranolol (obzidan), fosinopril (monopril) with and PCI; PCI conducted separately on hemodynamics on cardiohemodynamics on ekoendotoksikoz (AMP) and the clinical course of patients working in environmentally stressful conditions in the acute phase and follow-up of MI. Comparison of the results of complex mediakamentoz and mechanical revascularization with PCI conducted separately. Investigated 50 patients with STMI in the age of 30 to 70 years (56,7 ± 1,20 years). Of the 50 patients 25 were treated Cyto-Mac, foznopril, propranolol with heparin and PCI (group 1); 25 patients were treated with PCI alone (group 2). In both groups, blood was determined by the degree ekoendotoksikoza (AMP) by EchoCG and Doppler EchoCG studied ESV, EDV, EF, SI, CI , an local contractility violation index of left ventricle (LCVI) , with the aid of restenosis koronorografii. A well established dynamics of systolic and diastolic blood pressure, clinical features of MI during follow-up. Patients treatedheparin,Cуто-мас, propranolol, foznopril and PCIindicators of central hemodynamics stabilizis. The reduced ЕSV,EDV, LCVI and decreased degree ofekoendotoksikoza (АMP), improves left ventricular systolic function of demand , increases PV. However, in this group, one patient on the third day was recorded AHF and one recurrent MI. İn The group spent only 2 PCI in relapse developed MI, 1 - restenosis, 2 -AHF and 1 patients died. The results show that the combined application of drug therapy with PCI provides a positive result in comparsionwiththan separately conducted PCI in ACS with elevation ST.

Towards The Reduction of The National Impact of Blindness Due to Glaucoma- A National Glaucoma Summit

Glaucoma is a serious condition that involves elevation in pressure inside the eye caused by build-up of excess fluid. Though there are several varieties of the disease that do not show elevation of pressure inside the eyes, generally, glaucoma in whatever form, if left untreated would lead to impairment in vision by causing irreversible damage to the optic nerve and eventually blindness. Between 2005 and 2007 the National Programme for the Prevention of Blindness (NPPB), now known as National Eye Care Programme, in collaboration with states, local government and FCT embarked on National Blindness and low vision survey. The survey revealed that glaucoma, an unavoidable cause of blindness constitutes 16% of all blindness in the country. There are global initiatives that work to eradicate blindness in National communities in the developed and developing world. The major one being the Vision 2020 - the right to sight. Nigeria endorsed the initiative. This initiative is complacent on glaucoma as it is unavoidable, incurable and not within the targeted disease conditions of vision 2020. Elimination of blindness due to glaucoma in our communities, therefore calls for a National action. This paper is an advocacy for a National Summit on Glaucoma that would produce a National Glaucoma Eradication document; implementation of which would lead to reduction and elimination of the National impact of blindness due to glaucoma.

the Irradiation of Two Cases of Gliosarcoma: Place and Modalities of Radiotherapy

Introduction: Gliosarcoma is a rare histopathologic variant of glioblastoma traditionally associated with a poor prognosis.We present two cases of Gliosarcoma treated in our department. Discussion: Gliosarcoma (GSM) is a variant of glioblastoma (GBM), the most common primary malignant brain tumor that occurs in adults. GSM is characterized by its biphasic components: the gliomatous and sarcomatous components and categorized into primary and secondary GSM. Intrinsic to the brain parenchyma, GSM is usually managed by gross total resection, and radiotherapy with/without chemotherapy. Conclusion: Despite the notable advances and improvement in overall survival (OS), a consensus on the optimal treatment for GSM patients is unclear.

COVID-19 Pandemic and Clinical Oncology Concerns

Purpose: The purpose of this review article is concerns on thatcancer patients are regarded as a highly vulnerable group in the currentCoronavirus Disease 2019 (COVID-19) pandemic.Methods: A literature search was performed using the PubMeddatabase and the Cochrane library. Search terms included ”novel coronavirus”or “2019-nCoV” and “clinical oncology”. Authors re- viewedcancer registry information, status, and treatments.Results: COVID-19-infected cancer patients were included and the lastanti-tumor treatment was within 14 days, it significantly increased therisk of developing severe events. Lung cancer was the most frequentcancer type. The common chest computed tomography (CT) findingswere ground- glass opacity and patchy consolidation. A total of patientshad severe events and the mortality rate was high. Furthermore, patchyconsolidation on CT on admission was associated with a higher risk ofdeveloping severe events.Conclusions: Cancer patients show deteriorating conditions and pooroutcomes from the COVID-19 infection. It is recommended that cancerpatients receiving anti-tumor treatments should have vigorous screeningfor COVID-19 infection and should avoid treatments causing immunosuppression or have their dosages decreased in case of COVID-19infection.

Why Are SGLT2 Inhibitors Nephroprotective? Mechanisms of Action And Possible Benefits A Review

Recent researches have demonstrated that SGLT2i (Sodium-Glucose Linked Transporter 2 inhibitors) play a role in preventing the development and progression of chronic kidney disease (CKD). However, these studies have not to look into the mechanisms that justify this progress. In this document, we will approach the physiologic causes of the kidney response to SGLT2i treatment. SGLT2i were firstly designed as physiologic antidiabetic drugs due to its glucose anti-absorptive action in kidneys. Nevertheless, the effect on glucose levels has proved to be modest, so other different ways have to be involved in their renal benefits. After the commercialization of these drugs, their hypouricemic action, antihypertensive effects, and weight loss have been noticed. Although those actions are positive for the kidney, they are mild and hardly could induce a reduction of proteinuria and a kidney function stabilization effect. Other actions such as anti-inflammatory and metabolic could have more importance in the role of SGLT2i. SGLT2i have been shown to reduce hypoxia and fibrosis in the kidney by changing energetic balance and by reducing inflammatory activity. These two mechanisms are closely related to the settlement and progression of CKD. In addition, SGLT2i reduce proteinuria, which is probably the leading contribution of these drugs for renal function stabilization, due in part to its hemodynamic action by reducing intraglomerular pressure (tubule glomerular balance). In conclusion, SGLT2i kidney benefits could hardly be explained by a single effect. In fact, SGLT2i trigger several effects, that taken together explain the kidney improvements that have been described.