Analgesic activity of Hydroalcholic extract of Achyranthes aspera leaves on animal model

Achyranthes aspera L. (Family: Amaranthaceae) is widely used as a medicinal plant. The hydroalcholic extract of Achyranthes aspera L. leaves was screened for its analgesic activity. The dose (200 mg/kg) was tested for analgesic activity using hot plate and Tail flick test in albino mice. The hydroalcholic extract of Achyranthes aspera L. leaves showed maximum analgesic activity in hot plate at reaction time 120 min (7.40±0.08) and tail flick method at reaction time 120 min (6.9±0.06). These study suggest that the hydroalcholic extract of Achyranthes aspera L. could be considered as potential analgesic agent.

UHPLC-ESI-Orbitrap-HR-MS Analysis of Cyclopeptide Alkaloids From Ziziphus joazeiro

Ziziphus joazeiro Mart., popularly known as “juazeiro”, is a tree widely found in the northeast of Brazil. It is commonly used as an anti-inflammatory, antibacterial, antifungal, and analgesic agent. The stem extract exhibited, beside cytotoxic properties, substantial activity against the Gram-negative bacterium Allivibrio fischeri. UHPLC-ESI-Orbitrap-HR-MS analysis of the alkaloidal fraction of the crude methanolic stem extract of this species enabled the detection and putative identification of sixteen cyclopeptide alkaloids (CPAs), including four possibly new structures. According to the MS2 fragmentation analysis, from the sixteen identified CPAs, three possess a type-Ia1, one a type-Ia2, and twelve a type-Ib cyclopeptide alkaloid core. The structures of paliurine-C and -D were supported by NMR data.

SP7.1.3 An integrated and upgraded meta-analysis of published randomized, controlled trials exploring the role of oral metronidazole as post-operative proctological analgesic agent

Aims Proctological procedures such as haemorrhoidectomy have been reported with significant post-operative pain affecting quality of life as well as capacity to perform daily activities. The objective of this article is to explore the role of conventionally used antibiotic metronidazole as a proctological analgesic. Methods A systematic review of the randomized, controlled trials reporting the use of oral metronidazole as post-operative proctological analgesic agent in patients undergoing haemorrhoidectomy published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis. Results A total of eight randomized, controlled trials on 447 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of oral metronidazole as a post-operative proctological analgesic agent was significantly associated with the reduced pain score on day 1 (Standardized mean difference (SMD), -0.56; 95% CI, -1.04, -0.07; z = 2.26; P = 0.02), day 3 (SMD, -0.82; 95% CI, -1.33, -0.31; z = 3.15; P = 0.002) and day 7 (SMD, -1.48; 95% CI, -2.51, -0.45; z = 2.82; P = 0.005). There was significant heterogeneity (Tau2 = 0.39, chi2 = 38.38, df = 7, [p = 0.00001]; I2 = 82 %) among included studies. Conclusion The use of oral metronidazole as a post-operative proctological analgesic agent following haemorrhoidectomy seems to have proven clinical advantages and may routinely be used.

Hing (Ferula asafoetida). A Review Based Upon its Ayurvedic and Pharmacological Properties

Ferula is considered as the third largest genus of the family Apiaceae (Umbelliferae) which consists of 180-185 species. Asafoetida is defined as the oleo-resin gum extracted from the stem and rhizome of the Ferula asafetida plant. It is commonly called Hing or Devil's dung. It is a native species of Iran, Afghanistan and Pakistan. In Ayurveda, it is described as an analgesic agent and is mentioned in Charak Samhita. It carries a strong, tenacious and sulfurous odor. It is also used as a spice or as a condiment in various cookeries as a flavor like in curries, fresh vegetables, meat, pickles and pulses. Asafetida is distinguished as asafetida hing (hing) and asafetida (hingra). Traditionally, the plant is used to treat diseases like whooping cough, asthma, bronchitis, epilepsy, ulcer, stomachache, flatulence, bronchitis, antispasmodic, intestinal parasites, influenza and weak digestion. The main active constituents present in the Ferula asafetida plant are resins, gums and essential oils. From the reported studies it was found that the plant possesses various therapeutic and pharmacological properties like antioxidant, antimicrobial, antifungal, antiviral, antitumor, antimicrobial, antidiabetic, antispasmodic, hypertensive, hepatoprotective, neuroprotective and antiviral properties. In this review article, attempts have been made to describe the overall plant based on its modern and traditional view.

Potential Sedative and Therapeutic Value of Dexmedetomidine in Critical COVID-19 patients

The coronavirus 2019 disease (COVID-19) is an ongoing outbreak of respiratory disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus can invade various tissues and organs, causing multiple organ dysfunctions. Critically ill COVID-19 patients may develop acute respiratory distress syndrome and pneumonia, which are the major causes of hypoxemic respiratory failure and death due to SARS-CoV-2 infection. Thus, ventilation support (invasive or noninvasive), has become a common practice in respiratory treatment of COVID-19 patients. Patients receiving mechanical ventilation usually require sedation to alleviate anxiety, pain and discomfort. On the other hand, current clinical reports have indicated that a significant number of COVID-19 patients require prolonged intensive care unit (ICU) care and ventilation, which increases the risk of delirium. Thus, selection of appropriate sedative medications during this period is of utmost importance. Dexmedetomidine (DEX) is a sedative, anxiolytic and analgesic agent that acts through the α2-adrenoceptor. Its sedative property is notable due to the lack of respiratory depression. In addition, its cytoprotective, immunoregulatory and anti-inflammatory properties have been well established in preclinical settings. Based on these features, a number of recent studies have proposed DEX as a beneficial sedative agent that simultaneously mitigates the excessive inflammation and protects vital body organs in patients with severe COVID-19. In current brief review, we aimed to discuss the therapeutic benefits of DEX in managing different indications of COVID-19.

Kojic Acid: A Comprehensive Review

Due to the emerging nature of kojic acid, current project was conducted to introduce the abilities in details. KA is produced industrially by Aspergillus species in aerobic fermentation. Its structure was identified as 5-hydroxymethyl-pyrone. The KA plays an important role in determining certain chemical and physical properties it possesses. KA has different applications in various fields. It is broadly utilized in cosmetics, medicine, food, agriculture, chemical and other industries. These days kojic acid performs a vital function in cosmetics specically skin care products because it enhances the capability to prevent UV radiation it extensively utilized in whitening creams and lotions because of its anti tyrosinase activity. Kojic acid keeps getting hold on attention because of its economic potential as an anti-inflammatory and analgesic agent in the medical field. KA is utilized as an anti-bacterial agent in food industry & because of its antioxidant activity it is utilized as an antibrowning agent for agriculture products. Due to various uses of organic molecules the demand for kojic acid has rapidly increased. It also has some drawbacks, such as the KA is highly unstable upon exposure air and sunlight it changes its color and the other drawback is cytotoxicity which may be overcome by way of the formation of kojic acid peptides which are more stable.

Ketamine Prolonged Infusions in the Pediatric Intensive Care Unit: a Tertiary-Care Single-Center Analysis

OBJECTIVE Ketamine is commonly used as an anesthetic and analgesic agent for procedural sedation, but there is little evidence on its current use as a prolonged continuous infusion in the PICU. We sought to analyze the use of ketamine as a prolonged infusion in critically ill children, its indications, dosages, efficacy, and safety. METHODS We retrospectively reviewed the clinical charts of patients receiving ketamine for ≥24 hours in the period 2017–2018 in our tertiary care center. Data on concomitant treatments pre and 24 hours post ketamine introduction and adverse events were also collected. RESULTS Of the 60 patients included, 78% received ketamine as an adjuvant of analgosedation, 18% as an adjuvant of bronchospasm therapy, and 4% as an antiepileptic treatment. The median infusion duration was 103 hours (interquartile range [IQR], 58–159; range, 24–287), with median dosages between 15 (IQR, 10–20; range, 5–47) and 30 (IQR, 20–50; range, 10–100) mcg/kg/min. At 24 hours of ketamine infusion, dosages/kg/hr of opioids significantly decreased (p < 0.001), and 81% of patients had no increases in dosages of concomitant analgosedation. For 27% of patients with bronchospasm, the salbutamol infusions were lowered at 24 hours after ketamine introduction. Electroencephalograms of epileptic patients (n = 2) showed resolution of status epilepticus after ketamine administration. Adverse events most likely related to ketamine were hypertension (n = 1), hypersalivation (n = 1), and delirium (n = 1). CONCLUSIONS Ketamine can be considered a worthy strategy for the analgosedation of difficult-to-sedate patients. Its use for prolonged sedation allows the sparing of opioids. Its efficacy in patients with bronchospasm or status epilepticus still needs to be investigated.