Postoperative pain is one of the main postoperative adverse outcomes following caesarean section. Its management still remains a challenge especially in a low resource setting.
To compare the ...efficacy of intramuscular pentazocine alone and combined intramuscular pentazocine with diclofenac for pain relief within 24 hours after caesarean section.
This was a double blind randomized control study of post caesarean section pain management of 140 participants between April and December, 2015 at the Federal Teaching hospital, Abakaliki. Inclusion criteria involved consenting and low risk parturients who had caesarean section under spinal anaesthesia. The participants were randomly grouped into Pentazocine-Placebo (PP) group and Pentazocine-Diclofenac (PD) group. The PP group received pentazocine 30 mg every 4 hours for 24 hours and 3 milliliters of water for injection as placebo 12 hourly for 24 hours while the PD group received pentazocine 30 mg every 4 hours and diclofenac 75 mg every 12 hours for 24 hours. The level of pain control was assessed using the Visual Analog Scale (VAS). The data was analysed with IBM SPSS version 20.0. The level of significance was set at < 0.05.
The use of PD for 24 hour post caesarean section analgesia achieved better pain relief, faster onset of postoperative ambulation, bowel sound auscultation and oral feeding than the use of PP (p-value ≤0.002). However, the use of PD is more expensive than PP (p-value =0.0001). There was no difference between the two groups of participants on the passage of flatus and duration of hospital stay (p-value≥0.05). The use of PP was associated with more maternal side effects (p-value=0.009). There was no difference on the level of satisfaction between the two groups of participants (p-value≥0.05).
The use of PD for post caesarean section analgesia is more effective in achieving a satisfactory pain relief and has less side effects.
An electrochemical approach is introduced for the versatile carboxylation of multi-layered graphene in 0.1 M Bu4NBF4/MeCN. First, the graphene substrate (i.e., graphene chemically vapor-deposited on ...Ni) is negatively charged at −1.9 V versus Ag/AgI in a degassed solution to allow for intercalation of Bu4N+ and, thereby, separation of the individual graphene sheets. In the next step, the strongly activated and nucleophilic graphene is allowed to react with added carbon dioxide in an addition reaction, introducing carboxylate groups stabilized by Bu4N+ already present. This procedure may be carried out repetitively to further enhance the carboxylation degree under controlled conditions. Encouragingly, the same degree of control is even attainable, if the intercalation and carboxylation is carried out simultaneously in a one-step procedure, consisting of simply electrolyzing in a CO2-saturated solution at the graphene electrode for a given time. The same functionalization degree is obtained for all multi-layered regions, independent of the number of graphene sheets, which is due to the fact that the entire graphene structure is opened in response to the intercalation of Bu4N+. Hence, this electrochemical method offers a versatile procedure to make all graphene sheets in a multi-layered but expanded structure accessible for functionalization. On a more general level, this approach will provide a versatile way of forming new hybrid materials based on intimate bond coupling to graphene via carboxylate groups.
Survival after acute myocardial infarction has been enhanced by treatment with thrombolytic agents, aspirin, and β-adrenoceptor blockade. However, there remains a substantial subgroup of patients who ...manifest clinical evidence of heart failure despite the first two of these treatments, and for whom β-adrenoceptor antagonists are relatively or absolutely contraindicated. These patients have a greatly increased risk of fatal and non-fatal ischaemic, arrhythmic, and haemodynamic events. In this selected high-risk subset of patients we investigated the effect of therapy with the angiotensin converting enzyme (ACE) inhibitor ramipril, postulating that it would lengthen survival. 2006 patients who had shown clinical evidence of heart failure at any time after an acute myocardial infarction (AMI) were recruited from 144 centres in 14 countries. Patients were randomly allocated to double-blind treatment with either placebo (992 patients) or ramipril (1014 patients) on day 3 to day 10 after AMI (day 1). Patients with severe heart failure resistant to conventional therapy, in whom the attending physician considered the use of an ACE inhibitor to be mandatory, were excluded. Follow-up was continued for a minimum of 6 months and an average of 15 months. On intention-to-treat analysis mortality from all causes was significantly lower for patients randomised to receive ramipril (170 deaths; 17%) than for those randomised to receive placebo (222 deaths; 23%). The observed risk reduction was 27% (95% Cl 11% to 40%; p=0·002). Analysis of prespecified secondary outcomes revealed a risk reduction of 19% for the first validated outcome (ie, first event in an individual patient)—namely, death, severe/resistant heart failure, myocardial infarction, or stroke (95% CI 5% to 31%; p=0·008). Oral administration of ramipril to patients with clinical evidence of either transient or ongoing heart failure, initiated between the second and ninth day after myocardial infarction, resulted in a substantial reduction in premature death from all causes. This benefit was apparent as early as 30 days and was consistent across a range of subgroups.
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