Journal of Cellular & Molecular Anesthesia

Background: Apoptosis is a physiological programmed cell death necessary for   development and cellular homeostasis. Dysregulation of apoptosis pathways leads to a number of diseases such as cancer, autoimmune and immunodeficiency diseases, and neuro-degenerative disorders.  

Patients and methods: The current study included 56 patients (29 males and 27 females), undergoing corrective heart surgery operations, categorized into 3 groups: group A included 23 patients with atrial septal defect (ASD); group B included 15 patients with ventricular septal defect (VSD); and group C included 15 patients with fallot tetralogy. Biochemical assays of apoptotic (P53  and caspase 3) and antiapoptotic markers (Bcl-2) using  colorimetric and ELISA assay kits were performed to all included patients twice, preoperative and 24 hours postoperative.

 Results: No statistical significant difference was found in the preoperative levels of Bcl-2, Caspase-3 and P53 between the three groups. While significant difference was found when comparing the preoperative and postoperative levels of the previous markers in the same group and between groups (p˂0.05 for all).

Conclusion: Both apoptotic and antiapoptotic pathways are activated during congenital heart corrective surgeries. Degree of markers increase is directly related to duration of anesthesia exposure.

Key words: P53; caspase-3; Bcl-2; congenital heart corrective surgery; Apotosis.

ABSTRACT

Background and Aim: Age has a significant impact on neurodegenerative disease vulnerability. During aging, the level of oxidative stress is increasing that cause damage on the neurons, mitochondria, protein and DNA. Hence, brain aging has become a major risk factor for the development of neurodegenerative brain disorders such as Alzheimer’s disease and Parkinson disease. This study was carried out to determine the effectiveness of red palm oil (RPO) in preventing Alzheimer’s disease (AD) induced in rat as RPO that is known as natural sources that rich with antioxidant properties. Materials and Method: Forty male Sprague-Dawley rats were divided into 5 groups (n=8) that comprised of normal control group (saline water), negative control (D-Galactose, 100mg/kg), two treatment groups that were administered by RPO daily (200 and 400 mg/kg) and Donepezil, (0.25 mg/kg) were given as positive control for 21-days. Y-maze spontaneous alternation test was done weekly to evaluate the spatial working memory of the rats. At the end of treatment, biomarkers of oxidative stress such as GSH, SOD and neurotransmitter biomarkers, dopamine in the blood were measured through ELISA. Results: Rat pre-treated with RPO showed significant improvement in exploring new area as compared to untreated rat (p < 0.05). On the other hand, current results showed high level of dopamine and GSH in rats treated with RPO compared to D-galactose induced rat after 21 days of pre-treatment (p < 0.05). Meanwhile total SOD was increased in all group that were induced with D-galactose. Conclusions: Overall, RPO has been proven can improve cognitive impairment in rat with brain aging. This is owing to the antioxidant properties of RPO which play a vital role in preventing oxidative stress. In the future, RPO could appear as novel therapeutic molecular for brain disease.

Background: Intercostobrachial nerve (ICBN) innervates the upper half of the medial aspect of the arm and axilla. We hypothesized to assessing either pectoral nerves block type II (PECS II) or ICBN block would improve the quality of block for proximal arm arteriovenous access surgery.
Materials and Methods: In the study, forty adult patients with the end-stage renal disease aged between 18 and 70 years received a combined supraclavicular block with 30 ml 0.25% bupivacaine, and either ICBN (Group A, n = 20) or PECS II block with 10 ml 0.25% bupivacaine (Group B, n = 20) for proximal arm arteriovenous access surgery. The primary outcome was whether patients required intraoperative local anesthetic supplementation. Secondary outcomes were the volume of local anesthetic supplementation, fentanyl administration, Pain scores 24 hours postoperatively, and time to first postoperative rescue analgesia.
Results: Local anesthetic (LA) supplementation was required in 4 patients in group A and 6 patients in group B, and the mean volume of LA was lower in group A than group B as the complete sensory block in the medial side of the upper arm was achieved in 80% of patients in group A and 70 % in group B. There was a statistically significant decrease in time taken for blocks in group B (PECS) compared to group A and, the insignificant difference between the two studied groups regarding fentanyl received and time to 1st postoperative rescue analgesia.
Conclusion: ICBN and PECS blocks are ideal supplements to supraclavicular brachial (SCB) with statistically insignificant fewer patients in ICBN required LA volume and supplementation than PECS II block.

Background: Many studies have reported poor clinical outcomes regarding the ICU course of patients with severe COVID 19. Our study aimed at prospectively observing the predominant clinical pattern and outcomes in patients with severe COVID 19 admitted in the ICU.
Materials and Methods: This study was a retrospective, observational study of 100 patients admitted to the ICU with confirmed COVID 19. Data from all patients with confirmed COVID 19 admitted in ICU between 15 March 2021 to 25 April 2021 was included for this study. Patients were studied for their demographics, baseline comorbidities, laboratory investigations, and details of treatment. Major outcomes analyzed were clinical presentation, mechanical ventilation (MV) related mortality, and overall mortality of ICU patients. Student's independent t-test for comparing continuous variables and Chi-square test for categorical variables.
Results: Out of 220 patients with COVID-19, 100 were admitted to the ICU. The most common comorbidities were hypertension (38) and diabetes (25). Twenty-eight patients required mechanical ventilation (MV), out of which only 16 survived. MV LOS was longer for survivors than non-survivors. The overall mortality rate in ICU patients was 25%, and MV-related mortality was 42.85%.
Conclusion: The severity of presenting symptoms and presentation time play a major role in the outcome. Our study reports higher mortality in patients who required mechanical ventilation. This could be because of the increased severity of disease in these patients.

Background: Hypertension is the main factor to predict the severity and mortality of COVID-19. The use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is challenging. This study aimed to investigate the effect of ACEIs and ARBs on clinical outcomes in COVID-19 patients with hypertension.
Materials and Methods: This cross-sectional study was carried out on 498 patients who were referred to Razi hospital following COVID-19 development and also had hypertension. Patients were divided into two groups receiving drugs in the ACEIs and ARB's groups and those not receiving these drugs. The primary outcome was death up to one month after the onset of symptoms.
Results: Cardiovascular disease in patients taking ACEIs/ARBs was higher (p<0.001). One hundred eleven deaths (22.3%) were seen in the studied patients in whom 66 deaths (59.5%) belonged to the group not taking ACEIs and ARBs (p>0.05). Seventy-nine patients (15.86%) were admitted to ICU in which 62.03% of these patients died while the non-ICU mortality rate was 14.8% (Odds Ratio = 9.40; 95% CI: 5.54 to 15.95, p <0.001). A subgroup analysis found that among patients with diabetes who had hypertension, the incidence of death was 43.55% in the group taking ARBs/ACEi lower than in another group significant (p = 0.021).
Conclusion: The mortality rate in the patients taking ACEIs/ARBs is not different from other groups. It was found that among COVID-19 patients with diabetes who had hypertension, the incidence of death in the patients taking ARBs/ACEi was lower than in another group.

Background: Coronavirus disease 2019 (COVID -19) characterized by a mild to severe respiratory illness, has been affecting the world since late 2019 and leading to an increase in hospitalizations and deaths. There is still no specific highly effective treatment for this disease. This study aimed to compare the efficacy of the eight different treatment regimens for the hospitalized patients with COVID-19.

Methods: This retrospective cohort study was conducted on the hospitalized patients who had laboratory-confirmed COVID-19 by a real-time Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) of nasopharyngeal samples.

Results: Among all patients hospitalized with COVID-19 between March to September 2020, 861 patients were included in the study. This study indicated that treatment protocols included either remdesivir or favipiravir were superior to hydroxychloroquine in reducing the risk of in-hospital mortality of the patients with confirmed COVID-19, especially in critical patients defined as those who were ICU admitted or under mechanical ventilation (HR, 0.43; 95% CI, 0.23 to 0.82; P=0.011 and HR, 0.45; 95% CI, 0.22 to 0.90; P=0.024, respectively). Whereas receiving lopinavir/ritonavir in combination with either hydroxychloroquine plus interferon β and corticosteroids (HR, 1.85; 95% CI, 1.17 to 2.94; P=0.009), hydroxychloroquine plus interferon β (HR, 1.66; 95% CI, 1.01 to 2.74; P=0.046), or interferon β (HR, 1.80; 95% CI, 1.12 to 2.89; P=0.015) was associated with a significant increase in this risk.

Conclusion: Our findings indicate that using remdesivir and favipiravir in combination with interferon β and corticosteroids might be beneficial in hospitalized patients with COVID-19, especially in the critical ones.

Severe COVID-19 disease is currently being managed with glucocorticoids. As a result, there are increasing reports of COVID-19 associated mucormycosis. (CAM) Patients with diabetes mellitus, organ transplant recipients, and in immune-compromised patients either due to cancer chemotherapy or with HIV and AIDS are at high risk of developing CAM. Pharmacotherapy with antifungal agents like Amphotericin B and surgery are the main treatment options. In this narrative review, we will discuss the challenges and anesthetic concern while managing CAM.

We describe the effectiveness and safety of regional anesthesia in a patient with Duchenne muscular dystrophy (DMD) with a deranged coagulation profile. A 16-year-old male having DMD and congestive heart failure (CHF) presented to emergency with abdominal pain. Following cannula insertion, the patient developed compartment syndrome of the left forearm and hand. He was started on thrombolytic heparin infusion and the surgical team planned for an emergency fasciotomy. Ultrasound-guided axillary plexus block with ropivacaine allowed us to provide effective anesthesia for this patient avoiding the deleterious effects of general Anesthesia.

The design and development of a vaccine against the new coronavirus obtain an important goal of the global health community, which has developed and approved several vaccines, including the Oxford-AstraZeneca vaccine. The vaccine has been challenged because of reports of side effects after vaccination, while the level of immunity created by the vaccine has been confirmed. In this study, we examined the complication and change in laboratory tests of hematology, biochemistry, and enzymology in a 42-year-old woman with no history of specific disease after receiving the Oxford-AstraZeneca vaccine for 7 days. Our studies showed that following the injection of the vaccine, platelet, RBC, WBC decreased, and increased D-Dimer rates. Also that the standard rate has changed between Neutrophil, Lymphocyte, and Monocyte. There is evidence of Prothrombotic Immune Thrombocytopenia and following that there is a risk of the embolism, but the particular point is that this complication is temporary and the test process is progressing towards recovery.