Bupivacaine is an amide local anaesthetic used in hyperbaric and isobaric forms. These are administered intrathecally into the spine to provide regional anaesthesia for caesarean section. Several ...trials have compared hyperbaric and isobaric bupivacaine but none have conclusively shown benefit of either.
This systematic review aimed to summarize the effectiveness and safety of hyperbaric versus isobaric bupivacaine in providing anaesthesia for caesarean section. We considered the adequacy of anaesthesia for completion of caesarean section and the need for interventions to treat complications.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4), MEDLINE (January 1966 to May 2011) and EMBASE (January 1980 to May 2011). We handsearched journals. We imposed no language restriction. We reran our search in the above databases from January 2011 to January 2013; the studies are awaiting assessment and will be dealt with when we update the review.
We included all randomized controlled trials involving parturients undergoing spinal anaesthesia for elective caesarean section that compared the use of hyperbaric with isobaric bupivacaine.
Two authors independently extracted the data. The data that were extracted included the number of events and the sample sizes in both the intervention and control groups. For continuous outcomes, we extracted mean and standard deviation.We reported odds ratios and risk ratios (RR) for binary outcomes and mean differences (MD) for continuous outcomes.
We included six studies with a total of 394 patients in this review. Anaesthesia performed with hyperbaric bupivacaine appeared to be less likely to need conversion to general anaesthesia (two studies, 158 patients included in meta-analysis; RR 0.17, 95% confidence interval (CI) 0.03 to 0.94). There was no difference in the need for supplemental analgesics. The time till sensory block to the T4 level was also shorter with hyperbaric bupivacaine (two studies, 126 patients; MD -1.06 minutes, 95% CI -1.80 to -0.31). There were no other significant differences between the two anaesthetics.
The criteria for conversion to general anaesthesia should be clearly defined in future research. This review found that intrathecal hyperbaric bupivacaine had a more rapid onset of sensory blockade at the T4 level than isobaric bupivacaine. It may also result in less need for conversion to general anaesthesia and supplemental analgesia. However, due to the rarity of this outcome, variability in the dose, use of adjuvant drugs and differences in the technique used for regional anaesthesia the evidence is weak. Any apparent advantage of hyperbaric bupivacaine needs to be confirmed in larger randomized trials. There were no differences in the adverse effects studied.
A follow-up survey in 1997 to a 1992 study of the recommendations of an international expert panel on the use of benzodiazepines (BZDs) and other psychotherapeutic medications in the treatment of ...anxiety disorders suggests that the BZDs remain a mainstay of pharmacotherapy for most of these conditions. BZDs were mentioned more often than any other class of drugs as preferred first-line therapy for anxiety disorders, except obsessive compulsive disorder. The introduction of the selective serotonin reuptake inhibitors (SSRIs) did not significantly affect the experts’ recommendations for the use of BZDs as first-line pharmacotherapy. Rather, the SSRIs displaced the tricyclic antidepressants. Some implications of the continuing recommendations for the use of BZDs in anxiety disorders are discussed.
Abstract We report evidence for the charged charmed-strange baryon $$\Xi _{c}(2930)^+$$ Ξc(2930)+ with a signal significance of 3.9$$\sigma $$ σ with systematic errors included. The charged $$\Xi ..._{c}(2930)^+$$ Ξc(2930)+ is found in its decay to $$K_{S}^{0} \Lambda _{c}^+$$ KS0Λc+ in the substructure of $$\bar{B}^{0} \rightarrow K^{0}_{S} \Lambda _{c}^{+} \bar{\Lambda }_{c}^{-}$$ B¯0→KS0Λc+Λ¯c- decays. The measured mass and width are $$2942.3 \pm 4.4 ({\mathrm{stat.}}) \pm {1.5}({\mathrm{syst.}})$$ 2942.3±4.4(stat.)±1.5(syst.) MeV/$$c^{2}$$ c2 and $$14.8 \pm 8.8({\mathrm{stat.}}) \pm {2.5}({\mathrm{syst.}})$$ 14.8±8.8(stat.)±2.5(syst.) MeV, respectively, and the product branching fraction is $$\mathcal{B}(\bar{B}^{0} \rightarrow \Xi _c(2930)^{+} \bar{\Lambda }_{c}^{-}) \mathcal{B}(\Xi _c(2930)^{+}\rightarrow \bar{K}^{0} \Lambda _{c}^{+})=2.37 \pm 0.51 ({\mathrm{stat.}})\pm 0.31({\mathrm{syst.}})\times 10^{-4}$$ B(B¯0→Ξc(2930)+Λ¯c-)B(Ξc(2930)+→K¯0Λc+)=2.37±0.51(stat.)±0.31(syst.)×10-4 . We also measure $$\mathcal{B}(\bar{B}^{0} \rightarrow \bar{K}^{0} \Lambda _{c}^{+} \bar{\Lambda }_{c}^{-}) = 3.99 \pm 0.76({\mathrm{stat.}}) \pm 0.51({\mathrm{syst.}}) \times 10^{-4}$$ B(B¯0→K¯0Λc+Λ¯c-)=3.99±0.76(stat.)±0.51(syst.)×10-4 with greater precision than previous experiments, and present the results of a search for the charmonium-like state Y(4660) and its spin partner, $$Y_{\eta }$$ Yη , in the $$\Lambda _{c}^{+}\bar{\Lambda }_{c}^{-}$$ Λc+Λ¯c- invariant mass spectrum. No clear signals of the Y(4660) or $$Y_{\eta }$$ Yη are observed and the 90% credibility level (C.L.) upper limits on their production rates are determined. These measurements are obtained from a sample of $$(772\pm 11)\times 10^{6} B\bar{B}$$ (772±11)×106BB¯ pairs collected at the $$\Upsilon (4S)$$ Υ(4S) resonance by the Belle detector at the KEKB asymmetric energy electron-positron collider.
Abstract We report the first observation of the $$\Xi _{c}(2930)^0$$ Ξc(2930)0 charmed-strange baryon with a significance greater than 5$$\sigma $$ σ . The $$\Xi _{c}(2930)^0$$ Ξc(2930)0 is found in ...its decay to $$K^- \Lambda _{c}^+$$ K-Λc+ in $$B^{-} \rightarrow K^{-} \Lambda _{c}^{+} \bar{\Lambda }_{c}^{-}$$ B-→K-Λc+Λ¯c- decays. The measured mass and width are $$2928.9 \pm 3.0(\mathrm stat.)^{+0.9}_{-12.0}(\mathrm syst.)$$ 2928.9±3.0(stat.)-12.0+0.9(syst.) MeV/$$c^{2}$$ c2 and $$19.5 \pm 8.4(\mathrm stat.) ^{+5.9}_{-7.9}(\mathrm syst.)$$ 19.5±8.4(stat.)-7.9+5.9(syst.) MeV, respectively, and the product branching fraction is $$\mathcal{B}(B^{-} \rightarrow \Xi _{c}(2930)^0 \bar{\Lambda }_{c}^{-}) \mathcal{B}(\Xi _{c}(2930)^0 \rightarrow K^- \Lambda _{c}^{+})=1.73 \pm 0.45(\mathrm stat.) \pm 0.21(\mathrm syst.)\times 10^{-4}$$ B(B-→Ξc(2930)0Λ¯c-)B(Ξc(2930)0→K-Λc+)=1.73±0.45(stat.)±0.21(syst.)×10-4 . We also measure $$\mathcal{B}(B^{-} \rightarrow K^{-} \Lambda _{c}^{+} \bar{\Lambda }_{c}^{-}) = 4.80 \pm 0.43(\mathrm stat.) \pm 0.60(\mathrm syst.) \times 10^{-4}$$ B(B-→K-Λc+Λ¯c-)=4.80±0.43(stat.)±0.60(syst.)×10-4 with improved precision, and search for the charmonium-like state Y(4660) and its spin partner, $$Y_{\eta }$$ Yη , in the $$\Lambda _{c}^{+}\bar{\Lambda }_{c}^{-}$$ Λc+Λ¯c- invariant mass spectrum. No clear signals of the Y(4660) nor its spin partner are observed and the 90% credibility level (C.L.) upper limits on their production rates are determined. These measurements are obtained from a sample of $$(772\pm 11)\times 10^{6} B\bar{B}$$ (772±11)×106BB¯ pairs collected at the $$\Upsilon (4S)$$ Υ(4S) resonance by the Belle detector at the KEKB asymmetric energy electron–positron collider.
Blockade of voltage-gated Ca
2+ channels on sensory nerves attenuates neurotransmitter release and membrane hyperexcitability associated with chronic pain states. Identification of small molecule Ca
...2+ channel blockers that produce significant antinociception in the absence of deleterious hemodynamic effects has been challenging. In this report, two novel structurally related compounds, A-686085 and A-1048400, were identified that potently block N-type (IC
50
=
0.8
μM and 1.4
μM, respectively) and T-type (IC
50
=
4.6
μM and 1.2
μM, respectively) Ca
2+ channels in FLIPR based Ca
2+ flux assays. A-686085 also potently blocked L-type Ca
2+ channels (EC
50
=
0.6
μM), however, A-1048400 was much less active in blocking this channel (EC
50
=
28
μM). Both compounds dose-dependently reversed tactile allodynia in a model of capsaicin-induced secondary hypersensitivity with similar potencies (EC
50
=
300–365
ng/ml). However, A-686085 produced dose-related decreases in mean arterial pressure at antinociceptive plasma concentrations in the rat, while A-1048400 did not significantly alter hemodynamic function at supra-efficacious plasma concentrations. Electrophysiological studies demonstrated that A-1048400 blocks native N- and T-type Ca
2+ currents in rat dorsal root ganglion neurons (IC
50
=
3.0
μM and 1.6
μM, respectively) in a voltage-dependent fashion. In other experimental pain models, A-1048400 dose-dependently attenuated nociceptive, neuropathic and inflammatory pain at doses that did not alter psychomotor or hemodynamic function. The identification of A-1048400 provides further evidence that voltage-dependent inhibition of neuronal Ca
2+ channels coupled with pharmacological selectivity vs. L-type Ca
2+ channels can provide robust antinociception in the absence of deleterious effects on hemodynamic or psychomotor function.
Bread is one of the most convenient, least expensive and most important staple foods in the world today. It is usually fermented and baked into loaves or cakes. Bread making has been with the Chinese ...for 5000 years and has also been found in ancient Egyptian tombs and reported widely in the Old Testament of the Holy Bible and in the Holy Qur’an. Bread was introduced to Nigeria probably about two centuries ago either by white colonialists or it may have been acquired from the Arabs through the Trans-Saharan trade with the Fulanis and Hausas of Northern Nigeria, especially during the eras of Mali and Songhaï Empires. Wheat bread is widely consumed in all parts of Africa. Research into the use of indigenous raw materials in the production of composite bread, cakes and confectionery products has been carried out in several African research institutes and universities. These investigations have proven beyond doubt the baking potentials of various tropical crops including plantain and banana. Improved varieties of plantain and banana have been developed and widely distributed to farmers in West and Central Africa as well as East and Southern Africa by the International Institute of Tropical Agriculture (IITA). This effort was complemented by extensive post-harvest research on new product development and evaluation from various accessions of plantain and banana hybrids. Transformation of fruits at different stages of ripening involving different processing techniques, packaging and preservation of new products was disseminated to farmers and food processors. This was necessary to add value to fresh plantain and banana, reduce post-harvest loss, enhance product diversification and provide jobs. Despite these approaches, there has been limited effort to implement composite bread technology in developing countries at the industrial level. This paper is a review of the application of tropical crops, especially plantain and banana in bread making. Output of this review may provide impetus for sustainable adoption of non-wheat or composite wheat bread making technology in Africa.
Low dose local anaesthetic and fentanyl epidural solutions are commonly 'topped-up' for urgent caesarean section. However, the block characteristics associated with newer local anaesthetics such as ...ropivacaine 0.75% and levobupivacaine 0.5% have not been fully determined. In a randomised double-blinded controlled clinical trial, we compared 2% lignocaine with adrenaline and fentanyl (LAF), 0.75% ropivacaine and 0.5% levobupivacaine for extension of low dose epidural analgesia for urgent caesarean section in 90 Asian parturients. There was no significant difference in the median, interquartile range, time to T4 loss of sensation to cold between LAF (9.5, 7.0 to 13.3 minutes), 0.75% ropivacaine (10.0, 7.0 to 15.0 minutes) and 0.5% levobupivacaine (10.0, 7.0 to 15.0 minutes). No woman required conversion to general anaesthesia. The supplementation rate did not differ between groups. Levobupivacaine provided a longer duration of sensory block compared to LAF but a similar duration to 0.75% ropivacaine. Under the conditions of this study there was no significant difference in time to surgical readiness (defined as loss of sensation to cold to T4) between LAF, 0.75% ropivacaine and 0.5% levobupivacaine groups. Ropivacaine and levobupivacaine are suitable alternatives for extending epidural analgesia for urgent caesarean section.
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