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World Neurosurgery Jun 2024Magnesium sulfate (MgSO) is a potential neuroprotective agent for patients with aneurysmal subarachnoid hemorrhage (SAH). We analyzed the effect of early application of...
Early Intravenous Magnesium Sulfate and Its Impact on Cerebral Vasospasm as well as Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage: A Retrospective Matched Case-Control Analysis.
BACKGROUND
Magnesium sulfate (MgSO) is a potential neuroprotective agent for patients with aneurysmal subarachnoid hemorrhage (SAH). We analyzed the effect of early application of intraoperative intravenous MgSO and compared cerebral vasospasm (CV), delayed cerebral ischemia (DCI), and neurological outcome in 2 patient cohorts.
METHODS
A retrospective matched-pair analysis from patients at a single center in Germany was performed without (group A) and with (group B) MgSO application <24 hours after diagnosis. Pairs were matched according to the known risk factors for DCI and CV (age, Fisher grade, smoking, severity of SAH). Incidence of CV and DCI and neurological outcome using the modified Rankin Scale score 3 and 12 months after SAH were recorded.
RESULTS
The inclusion criteria were met by 196 patients. After risk stratification, 48 patients were included in the final analysis (age 54.2 ± 8.1 years; 30 women and 18 men) and were assigned to group A (n = 24) or group B (n = 24). CV occurred less frequently in group B (33%) than in group A (46%). Likewise, DCI was present in 13% in group B compared with 42% in group A. After 12 months, 22 patients in group B had a favorable functional outcome (modified Rankin Scale score 0-3) compared with 15 patients in group A.
CONCLUSIONS
In this study, the incidence of CV and DCI was lower in patients receiving intravenous MgSO within 24 hours after aneurysmal SAH onset. Favorable functional outcome was more likely in the MgSO group after 12 months of follow-up.
Topics: Humans; Magnesium Sulfate; Subarachnoid Hemorrhage; Female; Male; Middle Aged; Vasospasm, Intracranial; Retrospective Studies; Brain Ischemia; Case-Control Studies; Neuroprotective Agents; Adult; Administration, Intravenous; Aged; Treatment Outcome
PubMed: 38514031
DOI: 10.1016/j.wneu.2024.03.062 -
Journal of Pregnancy 2024To validate a model for predicting magnesium concentration in magnesium sulfate treatment in preeclampsia.
OBJECTIVE
To validate a model for predicting magnesium concentration in magnesium sulfate treatment in preeclampsia.
DESIGN
Retrospective cohort study. . Three secondary care hospitals, one accepting neonates from gestational week 28 + 0. . Women with preeclampsia undergoing magnesium sulfate treatment. Subjects initially received Zuspan treatment (4 g bolus and 1 g/h maintenance dose), commonly increased by individual titration. . Difference in mean between measured and predicted magnesium concentration. Proportion of women reaching target concentration (>2 mM) in 25 h.
RESULTS
56 women were included, with 356 magnesium measurements available. Mean magnesium concentration was 1.82 mM. The prediction model overestimated magnesium concentration by 0.10 mM (CI 0.04-0.16) but exhibited no bias for weight, creatinine, or treatment duration. Weighted mean infusion rate was 1.22 g/h during 30 hours. Overall success rate in reaching target concentration was 54%, decreasing to 40% in women > 95 kg. Overall success rate at 8 hours was 11%. No toxic concentrations were found.
CONCLUSIONS
Zuspan regimen is very safe, but slow to reach therapeutic concentrations-despite efforts of individual titration. Success rate is lower in heavy women, which is of particular importance considering their predisposition to develop preeclampsia. The validated pharmacokinetic model performs well and may be used to individually tailor treatment from the outset.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Pre-Eclampsia; Magnesium Sulfate; Magnesium; Retrospective Studies; Outcome Assessment, Health Care
PubMed: 38504794
DOI: 10.1155/2024/1178220 -
Se Pu = Chinese Journal of... Mar 2024, a perennial herb belonging to the Asteraceae family, is a vital ingredient in traditional Chinese medicine. Increased demands for the herb have led to its widespread...
[Determination of 35 prohibited pesticide residues in by modified QuEChERS method based on multi-walled carbon nanotubes coupled with gas chromatography-tandem mass spectrometry].
, a perennial herb belonging to the Asteraceae family, is a vital ingredient in traditional Chinese medicine. Increased demands for the herb have led to its widespread cultivation in China, but the corresponding increase in pesticide use has raised concerns about pesticide residues. Such residues would affect the safety and global market potential of . Thus, a simple method is crucial to detect pesticide residues. The QuEChERS technique, in combination with gas chromatography-tandem mass spectrometry (GC-MS/MS), is commonly used for residue detection. However, traditional adsorbents may be unable to purify complex herbal mixtures well, affecting accuracy and instrument performance. Choosing suitable purification materials for samples with complex matrices is of significant importance. This study focused on the detection of 35 prohibited pesticides in . A rapid detection method was established by combining the QuEChERS technique with GC-MS/MS and utilizing a combination of multiwalled carbon nanotubes (MWCNTs), octadecylsilane-bonded silica gel (C), and anhydrous magnesium sulfate (MgSO) as the purification adsorbent. The samples were extracted with acetonitrile, purified by an improved QuEChERS process, subjected to GC-MS/MS analysis in multiple reaction monitoring (MRM) mode, and quantified using the internal standard method. The purification effects of four materials (C, MWCNTs, -propyl ethylenediamine (PSA), and graphitized carbon black (GCB)) and their optimal dosages were investigated by considering the matrix characteristics of the samples. An orthogonal experimental design was employed to optimize the ratio of adsorbent combinations, and the optimal adsorbent combination was determined to be 450 mg of MgSO, 400 mg of C, and 50 mg of MWCNTs. Matrix effect (ME) evaluation of the matrix showed that 31 target compounds strongly exhibited matrix-enhancement effects. Thus, matrix-matched calibration was employed in this study. Methodological investigation revealed that the standard curves for the 35 pesticides exhibited good linearity, with correlation coefficients () greater than 0.9970. The average recoveries at three spiked levels ranged from 69.6% to 126.9%, and the relative standard deviations (RSDs) for parallel groups were all less than 10%. The limits of detection (LODs) and quantification (LOQs) ranged from 0.2 to 5.4 μg/kg and from 0.6 to 18.1 μg/kg, respectively. The developed method was used to screen and detect 35 pesticide residues in 20 batches of samples, and the target compounds were detected in six batches. The proposed method is simple, sensitive, and accurate. Thus, it is suitable for the rapid screening and detection of the 35 pesticide residues in and provides technical support for the cultivation, production, and quality control of the herb.
Topics: Tandem Mass Spectrometry; Gas Chromatography-Mass Spectrometry; Nanotubes, Carbon; Pesticide Residues; Saussurea
PubMed: 38503705
DOI: 10.3724/SP.J.1123.2023.07018 -
Boletin Medico Del Hospital Infantil de... 2024Preterm newborns require the use of the best and most current strategies to treat and prevent both acute pathology and associated sequelae. This study aimed to compare... (Observational Study)
Observational Study
BACKGROUND
Preterm newborns require the use of the best and most current strategies to treat and prevent both acute pathology and associated sequelae. This study aimed to compare the differences in the management of preterm newborns over 10 years in a tertiary hospital in Spain and its impact on height, weight, and neurological development in the medium term.
METHODS
We conducted a retrospective, observational, and analytical study examining the management and clinical variables in preterm newborns under 32 weeks of gestational age who were born in our hospital in 2011 and 2021.
RESULTS
Twenty-six newborns were included in the study. Significant differences in magnesium sulfate use, continuous positive airway pressure immediately after birth, and non-invasive mechanical ventilation during hospitalization were observed. Differences were found in the use of parenteral nutrition and the timing of initiation of enteral feeding. We did not observe differences in the neurological or weight evolution in the medium term.
CONCLUSIONS
Significant differences in managing preterm newborns in these 10 years were observed. Lower mortality and alterations in central nervous system ultrasound and, significantly, less growth retardation during admission in 2021 have been observed; however, it does not manifest with improvement in long-term somatometrics or neurological prognosis.
Topics: Infant, Newborn; Humans; Infant, Premature; Retrospective Studies; Gestational Age; Enteral Nutrition; Hospitals
PubMed: 38503320
DOI: 10.24875/BMHIM.23000093 -
Cureus Feb 2024Benzylisoquinolinium neuromuscular blocking agents can precipitate bronchospasm either through allergy/anaphylaxis or isolated stimulation of mast cell histamine...
Benzylisoquinolinium neuromuscular blocking agents can precipitate bronchospasm either through allergy/anaphylaxis or isolated stimulation of mast cell histamine release. This report presents a 75-year-old female who attended the day surgery unit for a rigid cystoscopy under general anaesthesia. She had a hyper-reactive airway history of mild historic asthma and sensitivity to aerosols. After administration of atracurium at induction of anaesthesia, ventilation became challenging with no chest rise and a flat CO trace. Repeat video laryngoscopy confirmed correct endotracheal tube position. The patient remained cardiovascularly stable with no mucocutaneous signs of anaphylaxis. Administration of high flow oxygen, sevoflurane, salbutamol and magnesium sulfate led to gradual improvement and normalisation of respiratory parameters. Surgery was postponed. This report highlights atracurium as an important trigger of bronchospasm at induction of anaesthesia, and illustrates that in rare cases a flat capnograph does not always indicate a mispositioned airway device. Several aspects of the anaesthetic plan for this patient were suboptimal given her respiratory history, namely, the choice of mode of anaesthesia and choice of neuromuscular blocking agent. These factors are discussed in the context of anaesthetic planning for patients presenting with features suggesting high bronchospastic risk.
PubMed: 38496062
DOI: 10.7759/cureus.54251 -
PLOS Global Public Health 2024Inequitable coverage of evidence-based MNCHN interventions is particularly pronounced in low and middle income countries where access and delivery of these interventions...
Perceived progress toward scale of 14 maternal, newborn, child health, and nutrition (MNCHN) assets at subnational level in Burkina Faso, Ethiopia, India, Kenya, and Nigeria.
Inequitable coverage of evidence-based MNCHN interventions is particularly pronounced in low and middle income countries where access and delivery of these interventions can vary dramatically at the subnational level. We conducted health system assessments in nine subnational geographies in five countries (Burkina Faso, Ethiopia, India, Kenya and Nigeria) to explore progress toward scale of 14 evidence-based MNCHN interventions (iron-folic acid, oxytocin, magnesium sulfate, misoprostol; 7.1% chlorhexidine for umbilical cord care, neonatal resuscitation, kangaroo mother care, community regimen for the treatment of possible severe bacterial infection; amoxicillin dispersible tablets, multiple micronutrient supplements, balanced energy protein supplementation, early and exclusive breastfeeding, feeding of small and sick newborns, and management of severe and moderate acute malnutrition in children less than five years old). Between March and October 2021, we conducted key informant interviews with a purposive sample of 275 healthcare providers and 94 district health management (DHMT) staff to better understand bottlenecks, facilitators and uptake of the interventions across varied subnational settings. Across all interventions and geographies, providers and DHMT staff perceived lack of robust HMIS data as the most significant barrier to scale followed by weak facility infrastructure. DHMT staff viewed limited budget allocation and training as a much larger barrier than healthcare providers, most likely given their purview as subnational managers. Healthcare providers were focused on supply chain and staffing, which affect workflows and service provision. Understanding provider and health facility management views of why interventions do or do not advance towards effective coverage can assist in creating enabling environments for the scale of best practices. These types of data are most helpful when collected at the subnational level, which allows for comparisons both within and between countries to show health disparities. Importantly, this strategic data collection can provide a starting point for improvement efforts to address existing health system gaps.
PubMed: 38489291
DOI: 10.1371/journal.pgph.0002309 -
Journal of Pain Research 2024The methods of perioperative analgesia and pain control have changed. The principle of opioid-based analgesia has been modified to multimodal analgesia, followed by LOA...
PURPOSE
The methods of perioperative analgesia and pain control have changed. The principle of opioid-based analgesia has been modified to multimodal analgesia, followed by LOA (low opioid anaesthesia) and OFA (opioid-free anaesthesia). The aim was to describe the effects of LOA on nausea, vomiting, and pain control during general anaesthesia and postoperative period after laparoscopic cholecystectomy.
PATIENTS AND METHODS
The protocol included the study group-40 patients received low-opioid anaesthesia (LOA), and the control group-40 patients received general anaesthesia with opioid analgesia (OA). The scheme of LOA was based on ketamine, lidocaine, magnesium sulfate, paracetamol, and metamizole. The OA was based on standard opioid (fentanyl) administration in induction and maintenance phase due to clinical observation. Postoperative analgesia included 1g of paracetamol and 1g of metamizol intravenously, with a 6-hour interval between doses.
RESULTS
Significant differences in the pain score in the periods of 2-6, 6-12, and 12-24 hours after anaesthesia between the groups were noticed (p < 0.001). Moreover, a significant difference in the frequency of nausea (p = 0.005) and vomiting (p = 0.04) between groups were presented. Nausea occurred in 54.05% of OA group, while in the LOA group, it occurred in a 23.08%. Vomiting occurred in 32.43% of control group, while in the study group, it occurred in 12.82% of patients.
CONCLUSION
The LOA protocol was more beneficial in reducing nausea and vomiting than the opioid-based method of anaesthesia. The LOA protocol of general anaesthesia during laparoscopic cholecystectomy and non-opioid postoperative analgesia have better outcomes in pain control, as well as nausea and vomiting, and improve postoperative patient comfort. The LOA protocol during anaesthesia and non-opioid postoperative analgesia should be considered in routine practice.
PubMed: 38476874
DOI: 10.2147/JPR.S449563 -
Indian Journal of Anaesthesia Mar 2024Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed...
BACKGROUND AND AIMS
Intraoperative regional analgesia and enhanced recovery are standard care models aimed at reducing perioperative opioid use following spine surgeries. This study aimed to examine the analgesic effect of retrolaminar block in promoting recovery and pain relief after posterior lumbar discectomy.
METHODS
The patients undergoing elective posterior lumbar discectomy were randomised into the retrolaminar group (n = 36) (received an intra-operative bilateral retrolaminar block with 15 mL of bupivacaine 0.25%, 2 mL (8 mg) of dexamethasone, and 2 mL of magnesium sulphate 10% (200 mg) on each side) and control group (n = 36) (received standard general anaesthesia). Primary outcomes were recovery time (time from isoflurane discontinuation to the first response to verbal command) and time to discharge (time from admission to the post-anaesthesia care unit (PACU) to discharge from the PACU, when Aldrete score was ≥9). values < 0.05 were considered statistically significant.
RESULTS
The extubation, recovery, and discharge times were significantly shorter in the retrolaminar group compared to the control group ( < 0.001). Postoperative pain scores were significantly lower in the retrolaminar group for up to 8 h compared to only 2 h in the control group ( < 0.001). The time to first administration of ketorolac post-operatively was significantly longer in the retrolaminar group compared to the control group ( < 0.001). The total consumption of ketorolac post-operatively was significantly reduced in the retrolaminar group compared to the control group ( < 0.001).
CONCLUSION
Intra-operative retrolaminar block is an easy and effective opioid-free regional anaesthesia technique that improves recovery after posterior lumbar discectomy.
PubMed: 38476544
DOI: 10.4103/ija.ija_773_23 -
Materials (Basel, Switzerland) Feb 2024In salt lake areas, cast-in situ concrete structures are subjected to long-term corrosion by sulfate and magnesium ions. The properties of concrete can be improved by...
In salt lake areas, cast-in situ concrete structures are subjected to long-term corrosion by sulfate and magnesium ions. The properties of concrete can be improved by adding materials like basalt fiber (BF). To investigate the degradation process and mechanism of cast-in situ concrete with premixed BF under the dual corrosion of sulfate and magnesium salts, concrete with a content of BF ranging from 0 to 0.5% was prepared. Specimens were subjected to different internal and external corrosion conditions and immersed for 180 days. Dimension, mass, and appearance changes at different immersion times were recorded. The compressive and flexural strength of the specimens were tested and continually observed throughout the immersion time. Mineral and microstructural changes at different immersion times were determined by the XRD, TG, and SEM analysis methods. Results indicated that external sulfate-internal magnesium combined attack had a significant negative effect on the early strength. The compressive and flexural strength of the corroded specimens decreased by 17.2% and 14.1%, respectively, compared to the control group at 28 days. The premixed magnesium ions caused the decomposition of the C-S-H gel, resulting in severe spalling and lower mechanical properties after immersing for a long time. As the BF can inhibit crack development, the properties of the concrete premixed with BF were improved. Specimens exhibited superior performance at a BF content of 0.5%, resulting in a 16.2% increase in flexural strength. This paper serves as a valuable reference for the application of basalt fiber-reinforced concrete under the challenging conditions of sulfate-magnesium combined attack.
PubMed: 38473599
DOI: 10.3390/ma17051128 -
Frontiers in Pharmacology 2024Perinatal hypoxia-ischemia represents a significant risk to CNS development, leading to high mortality rates, diverse damages, and persistent neurological deficits.... (Review)
Review
Perinatal hypoxia-ischemia represents a significant risk to CNS development, leading to high mortality rates, diverse damages, and persistent neurological deficits. Despite advances in neonatal medicine in recent decades, the incidence of HIE remains substantial. Motor deficits can manifest early, while cognitive impairments may be diagnosed later, emphasizing the need for extended follow-up. This review aims to explore potential candidates for therapeutic interventions for hypoxic-ischemic encephalopathy (HIE), with a focus on cognitive deficits. We searched randomized clinical trials (RCT) that tested drug treatments for HIE and evaluated cognitive outcomes. The results included studies on erythropoietin, melatonin, magnesium sulfate, topiramate, and a combination of vitamin C and ibuprofen. Although there are several indications of the efficacy of these drugs among animal models, considering neuroprotective properties, the RCTs failed to provide complete effectiveness in the context of cognitive impairments derived from HIE. More robust RCTs are still needed to advance our knowledge and to establish standardized treatments for HIE.
PubMed: 38469401
DOI: 10.3389/fphar.2024.1347529