Journal of Cellular & Molecular Anesthesia

Background: The etiological agent of COVID-19 is SARS-CoV-2. Conversional molecular methods used for detection of virus in COVID-19 infected patient. This study aimed to investigate the presence of escape mutations from molecular detection on SARS-CoV-2 targeted genes, which indicates importance of mutations in false negative PCR test results in detection of virus in clinical specimens of patients with COVID-19.

Material and Method: The 20 nasopharyngeal swabs samples collected from COVID-19 confirmed patients. The SARS-CoV-2 E, nsp12 and N genetic regions Amplified by RT-PCR assay. PCR products sequenced using the Sanger sequencing method and Multiple sequence alignment for the assessment of the polymorphism and mutations preformed using MEGA X software and Maximum likelihood method for the phylogenetic assessment.

Result: Among all COVID-19 cases 60% and 40% were male and female, respectively. The MSA showed high conservation between all of the evaluated samples and VOCs in all N, E and nsp12 genes. Also, the phylogenetic evaluation by Maximum likelihood method reported high similarity between all SARS-CoV-2 sequenced samples, VOCs and Wuhan reference sequence in evaluated region.

Conclusion: Our study results approved the relatively conserved suitability of the E, N and RdRp-gene regions without any diversity, therefore, making them perfect candidates for first-line screening.

Background: Posterior spinal fusion (PSF) is a common surgical operation used to correct degeneration of the lumbar spine with considerable postoperative pain. The primary objective of this study is to compare the total intraoperative and postoperative opioid consumption and numeric pain scale during the first 24 hours after surgery between the lidocaine/ketamine group and the narcotic-only group.

Materials and Methods: Sixty adult patients (age 18–65 years) scheduled for elective PSF were included. Patients were divided randomly into either the lidocaine/ketamine group (LK group), who received lidocaine and ketamine injection in addition to usual perioperative narcotic analgesia, and the narcotic-only group (N group) who depended on narcotics only. The primary outcome measures were total intraoperative and postoperative opioid consumption and pain scores during the first 24 hours postoperatively. The secondary outcome measures were sedation score, intravenous rescue analgesia, postoperative nausea and vomiting, and pruritis during the first 24 hours postoperatively.

Results: Patients in the LK group had lower intraoperative fentanyl consumption (216.3 ± 28.8 μg) than those in the N group (363 ± 35 μg). The LK group consumed less morphine during the first 24 hours after surgery (49.5 ± 6.0 mg) than the N group did (57.8 ± 8.6 mg). The LK group had lower pain scores at all-time intervals during the first 24 hours (2, 6, 12, and 24 hours) than the N group did.

Conclusions: Intraoperative lidocaine infusion with low-dose ketamine reduced opioid consumption and pain scores in patients undergoing PSF.

BACKGROUND: Preservative free 1% 2-chlorprocaine is a short acting local anesthetic agent that has a favourable profile for day care surgical procedures. Various adjuvants can be added to local anesthetics to potentiate their action. In this study, we compared the effect of intrathecal clonidine and fentanyl as an adjuvant to 1% 2-chloroprocaine (2-CP) in patients undergoing elective lower limb surgeries.

MATERIAL AND METHODS: Seventy patients of American Society of Anesthesiologists (ASA) grade 1 and 2 (18-60 years) scheduled for lower limb surgeries with duration of ≤60 minutes under spinal anesthesia were randomly divided into 2 groups (n= 35). Group CF received 1% 2-chloroprocaine 40 mg and fentanyl 20µg (4.5 ml). Group CC received 1% 2-chloroprocaine 40 mg and clonidine 15µg (4.5 ml). The onset and duration of sensory and motor blocks, time for demand of rescue analgesia, hemodynamics, and side effect, if any, were observed.

RESULTS: The onset and duration of sensory and motor blocks was significantly earlier in CC group. Time to demand of rescue analgesia was significantly prolonged in Group CC than CF.  Other side effects were comparable in two groups

CONCLUSION: Intrathecal clonidine (15 μg) is a better alternative to fentanyl (20 μg) used as an adjuvant to 1% 2-chloroprocaine for lower limb surgeries surgeries.

Background: According to a number of studies, calcitriol and tretinoin are able to regulate differentiation as well as the growth and of mesenchymal stem cells (MSCs). Nevertheless, the relationship between the supernatant of macrophage and mesenchymal stem cells is still under investigation. In the present work, a comparison is made between the modulated impacts of calcitriol and tretinoin treated mesenchymal stem cell supernatant on macrophage functions.

Materials and Methods: The isolation of mesenchymal stem cells was done using mouse bone marrow and the various concentrations of calcitriol (200 and 400 nM) and tretinoin (25, 50, and 100 nM) were used to pulse MSCs for 48 h. Macrophages were then applied to co-culture the supernatant of MSCs for 4 hr. Consequently, macrophages were assessed for respiratory burst.

Results:  Based on the obtained results, supernatant of bone marrow‐derived MSCs pulsed with calcitriol and tretinoin can have the potential for decreasing the respiratory burst of macrophages considerably in comparison with the control group. 

Conclusion: The anti‐inflammatory M2 macrophage polarization can be accelerated using calcitriol and tretinoin by mesenchymal stem cells.

Background: Coronavirus disease 2019 (COVID-19) had a pandemic spread worldwide. Most infected patients had a good prognosis, but some developed severe illnesses, which led to fatalities. It is urgent to define markers that reveal the severity of the disease. This study aimed to introduce the main plasma protein biomarkers involved in severe conditions versus mild infection states.

Materials and Methods: A total of 91 significant differentially expressed proteins (DEPs) in the sera of the patients with the severe condition versus mild states were extracted from an original article. The protein interaction is included in a network designed via STRING database and Cytoscape software to find the critical proteins which differentiate severe conditions versus mild states.

Results: A total of 6 hub nodes identified as critical target proteins were APOB, SERPINA1, CP, ORM1, HASPA8, and VW, according to the Degree value of nodes.

Conclusion: The expression of different biomarkers in the sera of COVID-19 patients can be considered differential markers that separate severe conditions from mild states; however, a more thorough investigation is required.

Keywords: COVID-19, Protein, Plasma, Biomarker, Network analysis

Background: Lung cancer is characterized by the uncontrolled growth of cells in the lung tissue. The purpose of the present study was to investigate the expression of MUC1 mRNA and CK19 mRNA biomarkers in patients with non-small-cell lung carcinoma (NSCLC).
Materials and Methods: In this case-control research, thirty samples of cancer blood, thirty samples of cancer tissue, and the same number of healthy samples were prepared. Samples were collected and RNA was extracted, then cDNA was made and gene expression was measured using Real-Time PCR.
Results: Among non-small-cell lung carcinoma patients, the MUC1 mRNA marker was positive for 19 individuals while in the healthy group, it was reported positive in 5 out of 30 individuals. In the patients' group, the CK19 mRNA marker was positive for 16 individuals while in the healthy group, in 6 out of 30 individuals.
Conclusion: The MUC1 mRNA and CK19 mRNA as lung cancer tumor markers were reliable and sensitive; however, further studies are recommended

In December 2019, unknown pneumonia appeared in Wuhan, China. The virus was then identified as a beta-coronavirus and referred to as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On 2 March 2020, ICTV named its disease COVID-19. This virus rapidly spread to many countries and regions in the world because of its human-to-human route of transmission. COVID-19 was declared as a pandemic on 11 March 2020. The average incubation period of the disease is 4 to 6 days and the clinical features of the infection vary, ranging from asymptomatic, mild to acute respiratory syndrome, multiple organ failure, and in people with underlying diseases, can lead to death.

The pathogenesis of COVID-19 starts by binding the virus spike to the angiotensin-converting enzyme 2 (ACE2) cellular receptor that expresses in many tissues. SARS-COV2 can manipulate the host cell immune elements by its specific proteins to evade the antiviral responses. Dysregulation in the host immune system activation can result in different outcomes of the disease. Although the exact mechanism of COVID-19 pathogenesis is still unclear, Preventive and control measures are needed to inhibit the virus rapid spreading. In the present study, we will briefly review the different aspects of COVID-19 pathogenesis.

Ebstein’s anomaly is a rare congenital heart disease constituting less than 1% of patients with congenital heart diseases.  It has diverse presentations, severity, and consequently, the management too. These patients are at increased risk of developing ventricular and supraventricular tachycardias, congestive heart failure, and even death. Here, we report a case of a 32-year old man with Ebstein’s anomaly, who had successfully undergone emergency open inguinal hernioplasty under nerve blocks.

Clinical manifestations of COVID-19 range from mild self-limiting illness to multi-organ dysfunction and acute respiratory distress syndrome (ARDS). Leptospirosis too manifests as mild or asymptomatic infection and only small number of patients progress to ARDS and develop systemic manifestation. COVID-19 and leptospira co infection can have fatal outcome because of augmented pathophysiological manifestations of both the disease. We here describe a case of leptospira and COVID-19 coinfection in a patient who had poor outcomes due to multi-organ involvement.

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