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After open thoracic surgery, post-thoracotomy pain remains an important postoperative problem affecting nearly half of patients. It can give rise to respiratory problems, delayed rehabilitation, prolonged hospitalizations, and chronic post-thoracotomy pain syndrome. Despite the reality that opioids are currently the primary source of anesthesia after surgery, their consumption is restricted by complications, including prolonged dependency, tolerance, and respiratory impairment. To maximize recovery after the thoracotomy, this narrative review incorporates some of the most current studies on opioid-free strategies. In addition to local anesthetic techniques, which include thoracic epidural analgesia, paravertebral block, and erector spinae plane block, the current study highlights the effectiveness of non-opioid pharmaceutical agents, which include acetaminophen, non-steroidal anti-inflammatory drugs, gabapentinoids, ketamine-based, steroids, and intravenous lidocaine. Physical therapy, respiratory therapy, and psychological assistance are examples of complementary non-pharmacologic interventions that improve postoperative recovery. By integrating such techniques as Enhanced Recovery. After Surgery (ERAS) pathways, individualized multidisciplinary analgesic procedures that reduce opioid consumption, promote the recovery process, and perhaps decrease the probability of chronic postoperative pain.
Central Nervous System (CNS) tumors are the leading solid malignancies in children, 50
Study DesignSystematic Review and Meta-Analysis.ObjectivesDespite a surge in the use of Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in spine surgery candidates, evidence on their perioperative use remains unclear. This meta-analysis aimed to synthesize the evidence on the safety and efficacy of GLP-1 RA use in patients undergoing spine surgeries.MethodsA systematic search of PubMed (MEDLINE), Embase, Scopus, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted. Studies that compared spine surgery outcomes in GLP-1 RA users and non-users were included. Two reviewers independently selected articles. (PROSPERO: CRD420251061447).ResultsEleven retrospective studies reporting on 27,143 patients were included. Three studies focused on the cervical spine, 6 on the lumbar spine, and 2 included all spinal fusions. Risk of bias was deemed to be low in all studies. There were no significant differences in the GLP-1 RA users and non-users in pooled estimates for pseudoarthrosis (odds ratio: 1.29 [95% CI: 0.09 - 19.23]), surgical site infections (0.97 [0.74 - 1.27]), pneumonia (1.19 [0.30 - 4.68]), deep vein thrombosis (1.34 [0.86 - 2.08]), acute kidney injury (1.27 [0.93 - 1.74]), readmission rate (1.06 [0.94 - 1.18]), and emergency department visits (0.95 [0.10 - 8.99]).ConclusionsCurrently available level 4 evidence suggests that perioperative GLP-1 RA use in spine surgery candidates does not affect the risk of postoperative complications. However, these studies are based on administrative databases and may be confounded by indication. Future studies should include glycemic control and weight loss to better elucidate the impact of GLP-1 RA.
Diffuse intrinsic pontine glioma (DIPG) is an aggressive pediatric brainstem tumor with a poor prognosis. In low- and middle-income countries (LMICs), challenges to diagnosis and treatment are exacerbated by limited resources and health system constraints. To evaluate diagnostic delays, access to imaging, biopsy and molecular testing, as well as treatment availability, including availability of standard treatment, palliative care and psychosocial support, in DIPG management across LMICs, alongside system-level barriers and survival outcomes. A systematic review was conducted according to PRISMA 2020 guidelines. Searches were performed across PubMed/MEDLINE, Scopus, CINAHL, and clinicaltrials.gov for studies up to December 2024. Two independent reviewers screened 2034 records. Data analysis and descriptive statistics were conducted using R version 4.5.0. This systematic review synthesized data from sixteen studies across six LMICs, encompassing 1527 DIPG cases, predominantly from South Asia (n = 8) and North Africa (n = 5). Significant diagnostic challenges were identified, with median delays of 1 to 6 months, largely attributed to inefficient referral pathways. While neuroimaging was available in most settings (14/16 studies), access to biopsies was limited. Although biopsy utilization reached 100
Valsartan (Val)-a lipophilic non-peptide angiotensin II type 1 receptor antagonist-is highly effective against hypertension and displaying limited solubility in water (3.08 μg/mL), thereby resulting in low oral bioavailability (23%). The limited water solubility of antihypertensive drugs can pose a challenge, particularly for rapid and precise administration. Herein, we synthesize and characterize valsartan-containing silver nanoparticles (Val-AgNPs) using Mangifera indica leaf extracts. The physicochemical, structural, thermal, and pharmacological properties of these nano-conjugates were established through various analytical and structural tools. The spectral shifts in both UV-visible and FTIR analyses indicate a successful interaction between the valsartan molecule and the silver nanoparticles. The resulting nano-conjugates are spherical and within the size range of 30-60 nm as revealed in scanning electron-EDS and atomic force micrographs. The log-normal distribution of valsartan-loaded nanoparticles, with a size range of 30 to 60 nm and a mode of 54 nm, indicates a narrow, monodisperse, and highly uniform particle size distribution. This is a favorable characteristic for drug delivery systems, as it leads to enhanced bioavailability and a consistent performance. Dynamic Light Scattering (DLS) analysis of the Val-AgNPs indicates a polydisperse sample with a tendency toward aggregation, resulting in larger effective sizes in the suspension compared to individual nanoparticles. The accompanying decrease in zeta potential (to -19.5 mV) and conductivity further supports the idea that the surface chemistry and stability of the nanoparticles changed after conjugation. Differential scanning calorimetry (DSC) demonstrated the melting onset of the valsartan component at 113.99 °C. The size-dependent densification of the silver nanoparticles at 286.24 °C correspond to a size range of 40-60 nm, showing a significant melting point depression compared to bulk silver due to nanoscale effects. The shift in Rf for pure valsartan to Val-AgNPs suggests that the interaction with the AgNPs alters the compound's overall polarity and/or its interaction with the stationary phase, complimented in HPTLC and HPLC analysis. The stability and offloading behavior of Val-AgNPs was observed at pH 6-10 and in 40% and 80% MeOH. In addition, Val-AgNPs did not reveal hemolysis or significant alterations in blood cell indices, confirming the safety of the nano-conjugates for biological application. In conclusion, these findings provide a comprehensive characterization of Val-AgNPs, highlighting their potential for improved drug delivery applications.
