Journal of Cellular & Molecular Anesthesia

In Collaboration with Anesthesiology Research Center, SBMU

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Journal of Cellular and Molecular Anesthesia (JCMA) is a scientific quarterly and peer-reviewed journal, with particular attention to translational anesthesiology and perioperative medicine. Disease-oriented basic research in cellular and molecular aspects of anesthesiology, including laboratory investigations, bench-to-bedside studies, or clinical research that yield new findings in molecular and cellular anesthesia and improve our diagnosis and therapeutics in clinical anesthesia are among the main targets in JCMA. Researches about Personalized Anesthesiology and Perioperative Medicine are other among the main areas of interest in the JCMA.

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Recent Submissions

Now showing 1 - 20 of 21
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    The Evaluation of the Effectiveness of Ginger Compared to Dexamethasone in Preventing Postoperative Nausea and Vomiting in Laparoscopic Nephrectomy
    (Brieflands, 2024-04-10) Mahtab Poorzamani; Behzad Narouie; Mohammad Hamidi Madani; Mohammad Hossein Soltani; Fatemeh Roodneshin; Ekram Mortazavi; Ahmad Saeed Yaqubi
    Background: Postoperative nausea and vomiting (PONV) is a common issue associated with laparoscopic procedures, prompting the exploration of various prevention methods. Objectives: This study aimed to assess the efficacy of Ginger capsules compared to Dexamethasone in preventing PONV following laparoscopic nephrectomy. Methods: A total of 131 patients undergoing laparoscopic nephrectomy were randomly assigned to receive either Ginger or Dexamethasone 30 minutes before anesthesia. Vomiting frequency in the recovery room and within the initial 24 hours post-surgery was recorded and compared between the two groups. Results: In the recovery room (within the first 6 hours post-surgery), vomiting occurred in 37% of patients in the Dexamethasone group and 11% in the Ginger group (P = 0.001). Similarly, within the first 24 hours post-operation, vomiting frequency was significantly lower in the Ginger group (19.7% vs. 47%: P = 0.001). Additionally, fewer patients in the Ginger group required intravenous medications like Ondansetron or Metoclopramide within the initial 24 hours post-surgery compared to the Dexamethasone group (8.2% vs. 38%, respectively; P = 0.001). Patients' self-reported post-surgical pain and discomfort using a Visual Analog Scale (VAS) showed no significant difference between the two groups (P = 0.45). No adverse effects were observed in either the Ginger or Dexamethasone groups. Conclusions: Ginger, administered in 500 mg oral capsules, is a safe and cost-effective option for reducing PONV incidence following laparoscopic nephrectomy.
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    Comparison of the Efficacy of Comfort Scale with State Behavioral Scale in Critically Ill Pediatrics Patients Under Mechanical Ventilation for Developing Sedation Protocol and Reducing Ventilator-Associated Pneumonia
    (Brieflands, 2024-04-03) Seyede Narjes Ahmadizadeh; Seyyed Alireza Mahdavi; Ghamartaj Khanbabaee; Hossein Saeedi; Seyyed Sajjad Razavi; Nazanin Hashemi Sabour
    Background: Proper sedation in ill children can enhance treatment outcomes, provide comfort, control pain, reduce delirium, and prevent self-extubation. This study aimed to compare the “Comfort Scale” with the “State Behavioral Scale” (SBS) in children under mechanical ventilation in the ICU to develop a sedation protocol. Methods: This study assessed 50 children, ranging from one month to 15 years of age, who were hospitalized in the ICU of Mofid Hospital for over four months. The convenience sampling method was used to select participants, who were then divided into two groups of 25 each (one for the Comfort Scale and one for the SBS). Data were analyzed using SPSS version 20, with a P-value of less than 0.05, which is considered statistically significant. Results: The mean age of the patients was 30.3 months (ranging from 1 to 150 months), with 19 female patients (38%) and 31 male patients (62%). The time taken for scoring by hospital staff was significantly shorter in the SBS group than in the Comfort Scale group (P < 0.0001). There were no significant differences between the two groups in terms of hospitalization duration and the amounts of benzodiazepines and opiates used (P > 0.05). Both tools were associated with a decrease in the length of hospitalization. Conclusions: The findings suggest that the SBS requires less time to administer than the Comfort Scale and can be considered a rapid method. Utilizing both the SBS and Comfort Scale can reduce the length of hospital stays and, consequently, the incidence of ventilator-associated pneumonia.
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    The Role of Ketamine in Calcium Changes in Intracellular Homeostasis and Mitochondrial Dysfunction
    (Brieflands, 2024-04-02) Siswo Legiran; Irfanuddin Unsri; Ramli Ahmad; Nurhadi Ibrahim; Rizal Zainal
    Ketamine was formerly introduced as an anesthesia drug and known as a non-competitive antagonist of the N-methyl-D-aspartate receptor (NMDAR). As knowledge grows, recent studies reveal the antidepressant effect of the drug. Moreover, a few investigations indicate that ketamine might be responsible for multiple calcium-regulated signaling pathways. Ketamine is thought to affect calcium homeostasis through several of its targets, such as N-Methyl-D-Aspartate (NMDA), α-amino-3-hydroxy-5-methylisoxazole-4-propionate acid receptors (AMPA), and voltage-dependent calcium channels (VDCCs).
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    Anesthetic Management of Difficult Airway Due to Maxillofacial Trauma in a Pregnant Patient Requiring Submental Intubation: A Case Report
    (Brieflands, 2024-04-02) Monika Yadav; Neha Ahuja; Abhishek Singh
    Managing a patient with maxillofacial trauma poses significant challenges, and when the patient is pregnant, these challenges are further heightened for an anesthesiologist. The optimal strategy to aid trauma patients is to provide immediate care, which includes managing the airway both in the pre-hospital setting and with advanced interventions within the critical first hour post-trauma, often referred to as the "golden hour." In this report, we detail the case of a twenty-week pregnant patient with maxillofacial trauma, which was successfully managed by a multidisciplinary team at our trauma center.
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    A Mini-review on the Necessity of Expanding Personalized Medicine for the Future of Various Aspects of Pain Management
    (Brieflands, 2024-03-27) Mastaneh Dahi Taleghani; Mohammad Reza Moshari; Reyhaneh Zahiri; Seyed Bashir Mirtajani; Maryam Vosoughian
    Pain is recognized as a deeply personal, psychological, and social sensation, the perception of which is influenced by diverse factors. The intensity and nature of pain vary among individuals, rendering pain a highly personal phenomenon that warrants tailored approaches. Precision medicine is a therapeutic paradigm grounded in the evaluation of multiple patient-specific factors, including environmental factors, lifestyle, and genetic variations, to determine the most suitable treatment approach for each individual. Research indicates that certain genetic variations can influence how individuals experience and respond to pain. While there is limited evidence in leveraging genetic testing results to tailor treatment approaches, recent years have shown promising outcomes in managing surgical pain or pain associated with opioid use or cessation.
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    Introducing a Possible Proteomic and Genomic Biomarker Panel Related to Methanol Poisoning: A Review
    (Brieflands, 2024-04-02) Alireza Ahmadzadeh; Fatemeh Bagheri; Babak Mostafazadeh; Shahin Shadnia; Mosatafa Rezaei-Tavirani; Vahid Mansouri; Reza Vafaee; Reza M Robati; Parviz Malekifar
    Context: Methanol is one of the simplest organic compounds widely used in industry. It is highly toxic and unfit for human consumption. The abuse of methanol-containing beverages is becoming a severe health problem. This review discusses new clinical and pathological manifestations alongside proteomic and genomic changes based on methanol's toxic effects. Evidence Acquisition: Medical literature was reviewed in Google Scholar, Scopus, and PubMed to examine the effect of methanol intoxication on proteomic and genomic changes in the human body. Results: The results revealed the rapid direct absorption of methanol and its spread in body tissues. Various side effects, from digestive problems to neurological disorders, blindness, and death, could occur depending on the consumed dosage. Methanol poisoning causes extensive changes at the protein level, affecting blood coagulation, vitamin metabolism, immune response, and lipid transport processes. Methanol could alter the gene expression profile pattern by increasing the production of free radical species, which cause changes in DNA nucleotides. Conclusions: In conclusion, since methanol poisoning is associated with serious adverse effects (protein expression changes) and mortality, it should be managed seriously and promptly.
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    Effect of South Sulawesi Propolis in Sevoflurane Anesthesia-Induced Rat Model During Weaning Period: Study Levels of IL-6, TNF⍺, IL-10, and PSD95 in the Prefrontal Cortex
    (Brieflands, 2024-03-30) Nuh Gusta Ady Yolanda; Trinovita Andraini; Roman Ardian Goenarjo; Nurhadi Ibrahim
    Background: A recent study discovered that exposure to the anesthetic gas sevoflurane in the early years of life can impact cognitive function. Objectives: This study aims to investigate the effects of prolonged and repeated exposure to sevoflurane during the weaning period and whether the administration of propolis, a well-known herbal substance with anti-inflammatory properties, has a beneficial effect on inflammation and synaptic markers in the prefrontal cortex area, as well as its effect on spatial working memory function. Methods: We utilized Sprague Dawley rats aged 21 days (P21), divided into three groups: Control, sevoflurane, and sevoflurane with propolis. The exposure to sevoflurane (3%) was conducted three times for 2 hours each at P21, P23, and P25. Propolis treatments were administered orally for four weeks, starting from the first day of exposure to sevoflurane. Analyses of IL-6, TNF-alpha, and IL-10 levels were performed using ELISA at P25 and P51, while spatial working memory was measured using the spontaneous Y-maze. Results: Exposure to sevoflurane during the weaning period had no effect on IL-6, TNF-alpha, IL-10, and PSD95 levels in the prefrontal cortex, nor on working memory function. Similarly, the administration of propolis did not have any beneficial effect on these parameters. Conclusions: Prolonged and repeated exposure to sevoflurane during the weaning period did not induce neuroinflammation conditions that would affect synaptic markers and working memory function. Further studies are required to identify a dose of sevoflurane that causes detrimental effects on memory function and to explore the beneficial effects of propolis on this condition.
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    Modulation of microRNA-133B in Post Mastectomy Pain Syndrome Following Yoga Intervention
    (Brieflands, 2024-04-02) Ashok K Saxena; Prakash Gondode; Geetanjali T Chilkoti; Tusha Sharma; Basu D Banerjee
    Objectives: This study aimed to compare the efficacy of yoga combined with an integrated multimodal approach on the incidence and severity of post-mastectomy pain syndrome (PMPS) and the role of miR-133B expressions in patients undergoing breast cancer surgery. Methods: With approval from the institutional ethics committee and informed consent obtained from each participant, forty patients of ASA grade I - II, aged 20 - 65 years, undergoing breast cancer surgery were included. Patients received a thoracic paravertebral block for up to 72 hours and pregabalin until the end of the fourth postoperative week. Patients were randomly allocated into two groups: “Control” and “yoga.” Patients in the Yoga group practiced the yogic exercise “Anulom-vilom" from the third day until the 90th day postoperatively. The delta-CT of miRNA-133B expression of genes on the 90th postoperative day was compared to the baseline, along with various pain intensity and quality of life parameters. Results: In the Yoga group, a significant up-regulation in miR-133B expression was observed on days 30 and 90 postoperatively. Patients with PMPS in the Yoga group showed a decreased ΔCT of miR-133B, indicating an up-regulation of gene expression, compared to the control group. A lower incidence of PMPS (10% vs. 30%) was observed in the experimental group, along with a significant enhancement of quality of life in post-mastectomy patients and decreased mean Visual Analogue Scale )VAS( pain scores, Pain Detect Questionnaire )PDQ( ، and Neuropathic Pain Symptom Inventory )NPSI( scores in the Yoga group; however, these were not statistically significant. Conclusions: The study demonstrated the feasibility of integrating yoga with a multimodal pain management approach and highlighted the role of miR-133B in the pathogenesis of PMPS.
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    Characterization of rrs and rpsL Mutations in Aminoglycoside-Resistant MycobacteriumTuberculosis Strains Isolated from Clinical Specimens in the West of Iran
    (Brieflands, 2024-03-30) Azadeh Farzamfar; Abbas Farahani; Parviz Mohajeri; Jebreil Shamseddin; Reza Habibipour; Mahsa Dastranj
    Background: The medical significance of drug resistance in Mycobacteriumtuberculosis, particularly the multi-drug-resistant strains, has a significant impact on the challenge of treating the disease and controlling its prevalence. Objectives: The objective of this study was to determine the frequency of rrs and rpsL mutations in aminoglycoside-resistant Mycobacteriumtuberculosis strains isolated from clinical specimens in western Iran. Methods: This descriptive cross-sectional study was conducted on positive sputum specimens obtained from 40 pulmonary disease patients referred to the Kermanshah Lung Disease Center. The sputum specimens were cultured on the Löwenstein–Jensen medium. Specimens were assessed for the presence of genes resistant and susceptible to aminoglycosides using gene expression methods. DNA extraction was performed using the G-spin kit, and the Polymerase Chain Reaction (PCR) method and hybridization technique were carried out using the AID kit. Results: Out of the 40 sputum samples, five (12.5%) were resistant to kanamycin/amikacin, and 12 (30%) showed resistance to streptomycin. Five mutation sites were identified in the codon 1400 of the rrs gene, which were associated with amikacin/kanamycin resistance. Additionally, nine other samples (22.5%) exhibited mutations in the Streptomycin-resistant rpsL A43G gene. Three samples (7.5%) showed mutations in the rrs C526T gene, conferring resistance to streptomycin. Conclusions: Our investigation revealed a significant frequency of resistance to drugs used as second-line medications. It must be noted that treating patients can be challenging when the frequency of multi-drug-resistant bacteria is high.
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    A Novel USG-Guided PEC Block with Ropivacaine and Fentanyl for Postoperative Analgesia in Chest Wall Surgeries: A Randomized Controlled Trial
    (Brieflands, 2024-03-30) Divya Kheskani; Heena Chhanwal; sejal Parmar; Aayushi Singh; Yash Patel
    Background: Perioperative analgesia can be administered through various routes to patients undergoing chest wall surgeries. A recently introduced technique is the ultrasound-guided pectoral nerve block, which aims to alleviate pain effectively. Objectives: The purpose of this study is to investigate and compare the total duration of analgesia and the timing of the first rescue analgesia. Methods: In this prospective, randomized, triple-blind study, 60 adult patients scheduled for elective chest wall surgeries were enrolled. They were randomly divided into two equal groups: Group R received 38 mL of 0.2% ropivacaine and 2 ml of normal saline, and group F received 38 mL of 0.2% ropivacaine and 2 mL of fentanyl (100 mcg). All patients were administered general anesthesia and the PEC1 and PEC2 blocks postoperatively prior to extubation. The primary objective was to assess the total duration of postoperative analgesia, the Numeric Rating Scale (NRS) pain score, and the time to first rescue analgesia in both groups. The secondary outcome was the total consumption of postoperative analgesics. Results: The total duration of analgesia, as well as the consumption of paracetamol and fentanyl postoperatively in group F, were 11.02 ± 2.01 hours, 1.5 ± 0.5 g, and 0 mcg, respectively. In contrast, in group R, these were 8.28 ± 0.51 hours, 2.2 ± 0.8 grams, and 35.1 ± 13.4 mcg, respectively. The NRS scores at rest and during movement in group F were lower compared to group R. Conclusions: Ultrasound-guided PEC1 and PEC2 blocks with fentanyl as an adjuvant to ropivacaine have significantly reduced the requirements for analgesia and pain scores.
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    Reduction of Surgical Bleeding During Lumbar Laminectomy with Pedicular Screw Using Oral Clonidine as a Premedication: A Randomized Comparative Study
    (Brieflands, 2024-03-26) Brahman Naghipour; Seyedeh Sorour Zahedi; Eisa Bilehjani; Farhad Mirzaei; Sepideh Sadat Zahedi; Sahar Zahedi
    Background: Spinal fusion surgeries are often associated with major blood loss. The aim of this study was to investigate the effect of oral clonidine as premedication on the amount of blood loss and the need for blood transfusion during lumbar laminectomy spine surgery with pedicle screw insertion, achieved by controlled hypotension. Methods: In this double-blind randomized clinical trial, 100 patients scheduled for lumbar spine laminectomy with pedicle screw insertion (as a fusion procedure) were included. Patients were classified into two groups: the intervention group received a 0.2 mg clonidine tablet one hour before entering the operating room, and the control group received a placebo. The patients were compared with respect to hemodynamic variables, quality of the surgical field, duration of the surgery, estimated amount of blood loss, and any blood transfusion. Results: Oral clonidine was found to be significantly better in terms of maintaining stable dynamics and having a lower amount of blood loss, thereby requiring fewer blood transfusions compared to the control group. Conclusions: Premedication with 0.2 mg oral clonidine in patients undergoing lumbar spine laminectomy with pedicle screw insertion results in improved perioperative hemodynamic stability and a reduction in the amount of intraoperative blood loss, thereby reducing the need for blood transfusion.
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    Insulin Ameliorates Neurodegeneration in an Experimental Animal Model of Brain Aging by a Decrease of GFAP Expression and Apoptosis Inhibition
    (Brieflands, 2024-03-31) Parnian Eslahi; Mohammad Amin Tofighi Zavareh; Mohammadhosssein Kargar Godaneh; Abbas Aliaghaei; Mohammad Ali Asghari; Ali Asghar Payvandi; Ali Younesi; Mohammad Mahdi Gheibi; Mohammadamin Sabbagh Alvani; Fatemeh Fadaei Fatabadi; Ali Mohammadhosein; Samareh Omidvari; Mohammad-Amin Abdollahifar; Hojjat Allah Abbaszadeh
    Background: Aging is one of the factors that will cause gradual changes in brain tissue and its destruction. One of the protective factors against aging is insulin. Objectives: Our study investigated insulin's neuroprotective effect by preventing oxidative stress-mediated neuronal damage. Methods: A total of 48 adult male NMRI (the Naval Medical Research Institute) mice were divided into 2 groups: control and insulin. Insulin was administered intraperitoneally (IP) for 8 weeks to the control group and for 12 weeks to the insulin group. In this study, animals were treated with insulin, and insulin's role in the aging process was evaluated. Then, brain tissue was extracted for evaluation of oxidative stress by assessment of glutathione disulfide (GSH) and reactive oxygen species (ROS) levels, the expression of the glial fibrillary acidic protein (GFAP) as a biomarker for astrogliosis, stereological study, and the real-time polymerase chain reaction (PCR) technique evaluated the level of apoptosis biomarker. Results: The results of stereological parameters show that the volumes of the brain cortex and the number of neurons improved in the insulin group by aging as compared to the control group. The results of real-time PCR showed that the expression level of apoptotic markers decreased in the insulin group compared to the control group. In the insulin group, GSH levels were higher than in the control group, and the control group produced more ROS than the insulin group. As compared with insulin, the control group expressed more GFAP protein and increased the number of glial cells by aging. Conclusions: The results showed that insulin could have neuroprotective effects against aging changes and reduce apoptosis and cell death.
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    Comparison Between 3 Different Norepinephrine Bolus Doses for Management of Postspinal Hypotension During the Caesarean Section for Patients with Preeclampsia: A Randomized Controlled Trial
    (Brieflands, 2024-03-31) Mohamed S Arafa; Sara A. Khattab; Ahmad El Salamony; Amr Abdelnasser; Ahmed Elsakka
    Background: There is no established dose for norepinephrine (NE) in the management of postspinal hypotension. The data on its use in women with preeclampsia (PE) are limited. Objectives: This study aimed to compare the effect of using different NE bolus doses for the management of postspinal hypotension during lower segment cesarean section for patients with PE. Methods: This randomized, double-blind trial included mothers with PE scheduled for cesarean delivery who developed postspinal hypotension. Sixty participants were allocated to receive 3, 4, or 5 µg of NE bolus. The primary outcome was the neonatal bicarbonate level. The secondary outcomes were successful management of hypotension, incidence of reactive hypertension, nausea, vomiting, systolic blood pressure (SBP), and heart rate (HR) readings through the operation, umbilical blood gases, and Apgar scores. Results: The number of hypotensive episodes, bradycardia episodes, successfully treated hypotensive episodes, and total NE dose per patient were lower in the 4- and 5-µg groups compared with the 3-µg group. Systolic blood pressure was generally higher in the 4- and 5-µg groups than in the 3-µg group starting from 12 min postspinal till 28 min postspinal. The heart rate decreased compared to the baseline reading starting from 4, 6, and 2 min postspinal in the 3-, 4-, and 5-µg groups, respectively, till 28 min postspinal. Also, HR was higher in the 4- and 5-µg groups compared to the 3-µg group at 6-12 min postspinal. Following the first NE bolus, SBP remained lower than the baseline reading in the 3 groups, and HR decreased compared to the baseline reading in the 3- and 5-µg groups only. Conclusions: The 3-, 4-, and 5-µg doses had comparable efficacy in managing the first hypotensive episode and comparable neonatal outcomes. The 4- and 5-µg doses significantly decreased the total NE requirements and the number of hypotensive episodes. The incidence of maternal bradycardia was not significantly different between the groups.
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    Machine Learning-Guided Anesthesiology: A Review of Recent Advances and Clinical Applications
    (Brieflands, 2024-03-31) Sana Hashemi; Zohreh Yousefzadeh; Ahmad Ali Abin; Azar Ejmalian; Shahabedin Nabavi; Ali Dabbagh
    Anesthesia is the process of inducing and experiencing various conditions, such as painlessness, immobility, and amnesia, to facilitate surgeries and other medical procedures. During the administration of anesthesia, anesthesiologists face critical decision-making moments, considering the significance of the procedure and potential complications resulting from anesthesia-related choices. In recent years, artificial intelligence (AI) has emerged as a supportive tool for anesthesia decisions, given its potential to assist with control and management tasks. This study aims to conduct a comprehensive review of articles on the intersection of AI and anesthesia. A review was conducted by searching PubMed for peer-reviewed articles published between 2020 and early 2022, using keywords related to anesthesia and AI. The articles were categorized into nine distinct groups: “Depth of anesthesia", “Control of anesthesia delivery", “Control of mechanical ventilation and weaning", “Event prediction", “Ultrasound guidance", “Pain management", “Operating room logistic", “Monitoring", and “Neuro-critical care". Four reviewers meticulously examined the selected articles to extract relevant information. The studies within each category were reviewed by considering items such as the purpose and type of anesthesia, AI algorithms, dataset, data accessibility, and evaluation criteria. To enhance clarity, each category was analyzed with a higher resolution than previous review articles, providing readers with key points, limitations, and potential areas for future research to facilitate a better understanding of each concept. The advancements in AI techniques hold promise in significantly enhancing anesthesia practices and improving the overall experience for anesthesiologists.
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    Special Real-time PCR and Conventional PCR for Detection of Rhino-Orbital-Cerebral Mucormycosis
    (Brieflands, 2024-03-31) Naghmeh Bahrami; Hamidreza Jamaati; Behrooz Farzanegan; Rezvan Azim Nejad; Farnoush Mohammadi; Mraj Naghdi; Seyedeh Zahra Fotook Kiaei; Abdolreza Mohamadnia
    Background: Mucormycosis is an invasive fungal infection that occurs in immunodeficiency patients and belongs to infections caused by mucoral fungi, such as Rhizopus and Rhizomucor. Objectives: This study investigated the identification and detection of the mucor fungus in tissue samples and other samples by the real-time polymerase chain reaction (PCR) method. Methods: This was a cross-sectional-descriptive study. A total of 80 tissue samples were collected from referring patients to diagnose fungi with the opinion of a specialist doctor. After extracting deoxyribonucleic acid (DNA) from the samples, PCR and real-time PCR tests were performed using specific primers for mucor and universal-pan and compared to culture. The results were confirmed by sequencing. Results: In this study, 80 samples were examined. In the PCR method, 74 and 75 cases of fungi were confirmed from the DNA obtained from the colonies and tissues, respectively. By using a specific primer for mucor, 12 patients were reported as positive for mucor. Additionally, 76 and 77 cases of fungi were confirmed in the real-time PCR method from the DNA obtained from the colonies and tissues, respectively, and positive cases were reported. By using specific primers and the real-time PCR test for mucor, 16 cases of mucor were reported from colonies, and 15 cases of mucor were reported positive from tissues. Conclusions: This study showed that real-time PCR and PCR are high-speed and more accurate methods than the culture test in identifying its species and have acceptable results in clinical cases.
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    Cellular Mechanisms Associated with Neurodevelopmental Alterations Produced by General Anesthetics
    (Brieflands, 2024-03-31) Alexander Trujillo Mejia; Paula Marcela Herrera Gomez
    There is concern about neurodevelopmental disturbances associated with exposure to general anesthesia during early childhood. In 2016, the U.S. Food and Drug Administration released a safety alert regarding the use of gamma-aminobutyric acid (GABA) agonists and N-methyl-D-aspartate (NMDA) receptor antagonists in pediatric anesthesia, warning about the risks of their use during the last trimester of pregnancy and in children under 3 years for neurodevelopment. Animal and in vitro studies demonstrate worrisome morphological and functional alterations in young neurons and glia induced by different anesthetic drugs. These drugs can induce changes in various neuronal transmission systems, alter dendritic growth and brain connectivity, and initiate processes leading to cell demise, such as aberrant cell cycle reentry, mitochondrial dysfunction, excitotoxicity, neuroapoptosis, disruption of cytoskeletal assembly, and dysregulation of brain-derived neurotrophic factor (BNDF). Additionally, they can generate epigenetic changes that can be transmitted intergenerationally. These effects are related to age, dose, number of anesthetics received, and duration of exposure to said drugs and can be reversible or permanent, caused by direct or indirect perturbations on neurons. These disturbances may manifest as neurodevelopmental disorders later in life. This work aimed to review the cellular mechanisms involved in these alterations.
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    In vitro Effects of Propofol and Bupivacaine on Pregnant Women’s Plasma Cholinesterase Activity and Malondialdehyde Level
    (Brieflands, 2024-03-31) Rozheen Shukri Karam; Fouad Kasim Mohammad
    Background: Propofol and bupivacaine are commonly used anesthetics for cesarean section (CS), and they might modulate plasma cholinesterase (ChE) activity and oxidative stress during the last stage of pregnancy. This study aimed to assess the in vitro effects of propofol and bupivacaine on plasma ChE activity and malondialdehyde (MDA) levels in pregnant women before undergoing elective CS. Methods: The plasma samples of 20 women set for elective CS were pooled for the in vitro determination of the effects of propofol and bupivacaine separately on plasma ChE activity (10 minutes of incubation with different concentrations at 37ºC) and the MDA level after the in vitro exposure of plasma samples containing different anesthetic concentrations to H2O2 (100 µM, incubated for 1 hour at 37ºC). Results: Bupivacaine at 1.1 and 2.2 µM significantly inhibited plasma ChE in vitro in a concentration-dependent manner by 13% and 20%, respectively. Propofol at 25 and 50 µM did not affect plasma ChE. A unique finding in this study was that both propofol and bupivacaine revealed an antioxidant effect, as both propofol at concentrations of 25, 50, and 100 µM and bupivacaine at 1.1, 2.2, and 4.4 µM reduced the MDA level in a concentration-dependent manner in vitro after the incubation of plasma samples with H2O2 as a source of oxidant. Conclusions: The in vitro findings suggest that bupivacaine exerts anti-ChE activity that should be taken into consideration in CS anesthesia, and both propofol and bupivacaine possess antioxidant properties that need additional clinical studies.
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    Effect of CoQ10 Addition to Rectal Indomethacin on Clinical Pancreatitis and Related Biomarkers in Post-endoscopic Retrograde Cholangiopancreatography
    (Brieflands, 2024-03-31) Saeed Abdi; Roja Qobadighadikolaei; Faezeh Jamali; Maryam Shahrokhi; Farzaneh Dastan; Mohammad Abbasinazari
    Background: Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most prevalent complication of ERCP. Oxidative stress has been mentioned as a cause of PEP. Objectives: As preclinical and clinical studies have shown that CoQ10 has anti-inflammatory and antioxidant effects, the present study was designed to examine whether oral CoQ10 addition to rectal indomethacin decreases the rate/severity of PEP. Methods: A prospective double-blind clinical study was done on 347 patients undergoing ERCP. All participants received 100 mg rectal indomethacin just before ERCP. Also, patients were asked to consume CoQ10 (200 mg) or an identical placebo for 1 h before the procedure. The occurrence and severity of PEP were determined in the participants. The levels of amylase, lipase, and malondialdehyde (MDA) were also measured 12 h after ERCP. Results: The total rate of PEP was equal to 12.1% in intention-to-treat (ITT) and 13% in per-protocol (PP) analyses. A meaningful difference was observed in the rate and severity of PEP between the CoQ10 and placebo arms (9.8% vs 14.4% in ITT and 10.2% vs 15.1% in PP, sequentially). Secondary levels of amylase, lipase, and MDA were lower in the CoQ10 arm than in the placebo arm (P = 0.032, 0.022, and 0.036, sequentially). Conclusions: A combination of oral CoQ (200 mg) plus rectal indomethacin (100 mg) could decrease the PEP rate and severity meaningfully compared to the use of indomethacin alone.
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    Central Neuraxial Blocks as Surgical Anesthesia in Infants: A Narrative Review
    (Brieflands, 2024-03-31) Raghuraman M Sethuraman
    Perioperative care of neonates/infants is a great challenge for anesthesiologists, regardless of the type of anesthesia chosen. Furthermore, providing regional anesthesia techniques as “surgical anesthesia" in this population is even more difficult. In this review, the merits and demerits of all available techniques of central neuraxial blocks (CNBs) are discussed in detail, and their recent advances are discussed. The “research gaps” on this topic are also highlighted. The author hopes it would be a valuable addition to the literature and lead to further research on this potential topic.
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    Paresis Following Type A Botulinum Toxin (Dysport) Injection: A Case Report
    (Brieflands, 2024-06-30) Sara Salarian; Masoomeh Raoufi; Sogol Asgari; Faranak Behnaz; Behnam Safarpour Lima
    Primary hyperhidrosis (PH) is a condition characterized by excessive sweating. Primary treatment options include antiperspirants or anticholinergics for symptomatic relief, while axillary and palmar hyperhidrosis can be addressed with surgery. Botulinum toxin type A (BTX-A) is a significant treatment option for these patients. This toxin inhibits the release of acetylcholine, preventing overactive eccrine sweat glands from causing excessive sweating. Despite its effectiveness in treating various neurological and cosmetic conditions, Botox may pose the risk of severe side effects resulting from local or systemic drug release. We report the case of a 21-year-old woman who developed weakness in all four limbs, dyspnea, dysphagia, and blurred vision two weeks after botulinum toxin injection for hyperhidrosis treatment.