Dexamethasone

Main objective: The main aim of this study was to assess the incidence of metabolic complications (hypertension and diabetes) in mothers treated with DEX during pregnancy. Secondary objectives: 1. To assess the prevalence and importance of adverse effects of DEX: weight gain, stretch marks, insomnia in mothers treated with DEX. 2. Describe pregnancy outcomes and compare them with a reference population (data from the 2010 French perinatal survey (15)). 3. Analyze the corticotropic axis of DEX-treated mothers during and after pregnancy.

Caesarean section (CS) is the most common abdominal surgery among women worldwide. Inadequately treated postoperative pain can contribute significantly to morbidity of surgical patients, resulting in the delay of patients' recovery and ability to return to daily functional activities, increased incidence of chronic pain, and post-traumatic stress syndrome. The ultrasound-guided erector spinae plane (ESP) block is a recently described interfascial paraspinal plane technique that was initially used by Forero et al. for providing thoracic analgesia when performed at the level of T5 transverse process. Since the pain experienced after caesarean delivery using a Pfannenstiel incision has both a somatic and visceral component. Magnesium sulfate (MgSO4) may be helpful as an analgesic adjuvant in regional anesthesia because it improves and prolongs the analgesic effect of local anesthetics. Dexamethasone is a potent glucocorticoid medication commonly used as an adjuvant to reduce postoperative pain. The mechanisms of perineurally administered dexamethasone are likely attributed to complex interactions, including direct inhibition of signal transmission in nociceptive C fibres, local vasoconstriction, and reduced local inflammation.

Postoperative nausea and vomiting (PONV) is a common consequence of ambulatory surgery, affecting up to 80% of high-risk patients and 20-30% overall.(1) Despite being widespread, a prior survey found that patients are more averse to PONV than pain and other significant postoperative problems.(2) Furthermore, even mild cases of PONV can have serious repercussions, such as postanesthesia care unit (PACU) workflow disruption, delayed discharges, higher medical costs, and lower patient satisfaction.(3)PONV following intraocular surgery can be unpleasant and may lead to serious complications including suprachoroidal hemorrhage (SCH).(4) SCH is a potentially serious condition that occurs when the posterior ciliary arteries or vortex veins burst, resulting in blood in the suprachoroidal region.(5) Several medications are proved to be effective for prevention of nausea and vomiting like steroids, dopamine antagonists and serotonin antagonists. PONV is best prevented and treated with selective serotonin receptor antagonists. Although serotonin receptor antagonists are more successful than metoclopramide and dexamethasone in preventing and treating PONV, their usage is restricted due to their expensive cost and limited availability in resource-poor facilities.(6) In an attempt to decrease the incidence of PONV in the ambulatory setting, several anti-emetics have been studied.(7) For decades, metoclopramide has been a popular antiemetic due to its dose-dependent activity on central dopaminergic D2 receptors, central and peripheral 5-HT3 receptors, and peripheral 5-HT4 receptors. Despite inconsistent results, it is nevertheless commonly used in clinical practice to prevent nausea and vomiting after surgery.(8) Dexamethasone was utilized as a standalone medication during surgery for both pediatric and adult patients.(9) Recently, there has been a suggestion that dexamethasone, which has been shown to be more effective in preventing nausea and is thought to lower 5-HT levels in the central nervous system, could lower the incidence of PONV.(10) The hypothesis is that dexamethasone will lower the incidence of PONV after cataract surgery when compared with metoclopramide. Aim of the work: The present study aims to test the efficacy of dexamethasone and metoclopramide in prevention of PONV in patients undergoing cataract surgery. Primary outcome: • Incidence of PONV Secondary outcomes: * Number of patients took antiemetic drug in 24h * Postoperative pain score Patients : Study settings: This study will be conducted in ophthalmology department, Alexandria university hospitals. Study design: Placebo-controlled, double blind, randomized, prospective study Sample size calculation: Study population: All patients will be randomized 1:1 using a sealed envelope method. Patients will be divided into three equal groups: Group P: patients will receive 0.9% normal saline Group M: patients will receive 10 mg metoclopramide Group D: patients will receive 8 mg dexamethasone Methods: Preoperative evaluation and preparation: During preoperative visit, evaluation of patients will be carried out through proper history taking, clinical examination and routine laboratory investigations including complete blood picture, coagulation profile, blood urea, serum creatinine, serum electrolytes and any other investigation needed. Pre-anesthetic preparation and premedication: * Informed written consent, from all individual participants who will be included in this study will be taken during preoperative visit. * Patients should be trained during preoperative visit on a visual analogue scale (VAS), with 0 corresponding to no pain and 10 to the worst pain imaginable On arrival to operative theatre, intravenous cannula will be inserted and standard monitoring will be established using multichannel monitor (Carescape Monitor B650, GE Healthcare Finland) to monitor the following in both groups: * Electrocardiogram (ECG) for heart rate and rhythm. (Beats/min). * Non-invasive measurement of arterial blood pressure. (Mean blood pressure in mmHg). * Pulse oxygen saturation. (SpO2%). Before sedation, patients will be randomly allocated to receive one of three drugs. Three 2-mL syringes containing either 8 mg dexamethasone,10 mg metoclopramide, or 0.9% saline per syringe will be prepared by an anesthetist who is not one of the observers. Syringes will be marked with a coded label. Patients in group P will receive 0.9% normal saline, group M will receive 10 mg metoclopramide and group D will receive 8 mg dexamethasone before sedation. All patients will be sedated with 0.025 mg /kg midazolam, 0.25 mg/kg ketamine and 0.05 mg/kg nalbuphine. Peribulbar block with 2 ml lidocaine 2% and 3 ml bupivacaine 0.5% will be given to all patients. The rescue antiemetic will be ondansetron 4 mg IV, which will be given for prolonged nausea (exceeding 10 min) or vomiting or at the patient's request and will be repeated if necessary. Pain will be assessed using VAS. Nausea will be assessed using a linear numerical scale of 0-3 (0=none, 1=mild, 2=moderate, 3=severe). The rescue analgesic will be intravenous ketorolac 30 mg if VAS \>3. Nausea refers to the unpleasant sensation of wanting to vomit, while vomiting is the forceful ejection of gastric contents from the mouth.

Carpal tunnel syndrome (CTS) is a collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunnel. Corticosteroid injection is an extensively used and accepted treatment in mild to moderate CTS according to the guidelines of the American Academy of Orthopedic Surgeons as corticosteroids reduce the inflammation and edema associated with CTS. However, there is no guideline as to which corticosteroid has to be used as the standard treatment in CTS. Triamcinolone acetonide, a commonly used steroid for this indication, is a particulate steroid, which can cause permanent nerve injury if accidentally injected into the nerve. Local ozone injection as a therapeutic option in some musculoskeletal conditions; ozone (O3) gas is a molecule consisting of three oxygen atoms in a dynamically unstable structure. Ozone therapy has been utilized and studied for more than a century.

In this study the investigators aim to compare the effect of the suprascapular- supraclavicular nerve block in association with dexamethasone to that of the interscalene brachial plexus block on analgesic effect during arthroscopic shoulder surgery, as postoperative pain scores ,postoperative consumption of analgesic rescue medications and diaphragmatic excursion assessment.

Some patients are at high risk of Pre term birth and therefore they are advised antenatal steroids which facilitates fetal lung development preparing it for smoother transition for extra-uterine life. Dexamethasone and Betamethasone are commonly used for this purpose but differently effect fetal cardiac activity as evident by CTG changes and awareness of these phenomena would prevent iatrogenic delivery of preterm fetuses.

Study will be conducted after the approval of Institutional Ethics Review Committee, AFID (ANX "A"). A total of 130 entitled patients reporting to Operative Dentistry Department, Armed Forces Institute of Dentistry will be invited for participation in this study. The procedure will be explained to the patients and their parents in Urdu language and a written informed consent will be taken (ANX "B") They will be screened for inclusion by taking history, performing relevant clinical examination and necessary tests along with peri-apical radiographs. Patients fulfilling the inclusion criteria will be divided into two groups using consecutive non random sampling. Group 1: Patients treated with premedication of Non steroidal anti inflammatory drug (Ibuprofen) Group 2: Patients treated with premedication of Steroidal anti inflammatory drug (Dexamethsone) Both groups will receive medication 15 mins before intiating root canal treatment. Root canal treatment will then be initiated under local anesthesia and rubber dam isolation. Working length will be taken 1mm from radiographic apex with apex locator and will be confirmed with radiograph. The root canals will be instrumented with ProTaper Next system under copious irrigation with 5.25% sodium hypochlorite (NaOCl). Patency will be confirmed with a #10 K file between each instrument change. The root canals will be flushed with 5 mL of 17% EDTA solution. To control the microbiological impact on post-operative pain calcium hydroxide will be used as an intra-canal medicament and likewise 5.25% sodium hypochlorite as an irrigant in both groups. Following instrumentation and calcium hydroxide placement in the canal using lentulo spirals, the cavity will be temporarily sealed with cavit. At the end of every appointment, patient will be given a visual analogue scale. The patient will be advised to mark the line corresponding with the intensity of his pain at 24, 48 and 72 hours after the first visit. The patient will be recalled after one week for obturation and final full coverage restoration. Analgesics will be prescribed in case of severe intolerable pain.

IgA nephropathy is a glomerulonephritis characterized by pathological IgA deposition in the mesangial region. Its clinical and pathological manifestations are diverse and heterogeneous. Its pathogenesis has not yet been fully clarified, and there is currently no unified treatment plan. As a recombinant human B lymphocyte stimulator receptor-antibody fusion protein, telitacicept has become a new therapeutic target. The results of the Phase II clinical trial of this drug for IgA nephropathy have already been published. It is one of the key pioneering clinical studies in the field of IgA nephropathy treatment. The study showed that telitacicept can effectively reduce patients' proteinuria and reduce the risk of disease progression. Based on the above research results, the investigators plan to conduct a multicenter, randomized, controlled clinical study to evaluate the efficacy and safety of telitacicept in the treatment of primary IgA nephropathy patients with a high risk of progression.

Background: Enhanced Recovery After Surgery (ERAS) is a concept that aims to achieve faster patient recovery and fewer complications after major surgery. Spinal anesthesia is a technique widely used for Cesarean Delivery (CD), where a local anesthetic is administered along with opioids such as fentanyl and morphine. Antiemetic agents have been used prophylactically during CD under spinal anesthesia. The efficacy of combination antiemetic agents to prevent nausea and vomiting in patients who underwent CD has been established, hence, a multi-modal anti-emetic approach has been advocated for ERAS for CD. Dexamethasone is a corticosteroid that has been found to significantly prevent nausea and vomiting and decrease postoperative pain. Dexamethasone has been shown to prolong the durations of sensory and motor blockade for peripheral nerve blocks. Despite the knowledge that dexamethasone is a useful adjunct for extending local anesthetic duration and reducing postoperative pain, only one study has examined its application in spinal anesthesia for CD. In this study, authors found 8mg of IV dexamethasone increased the mean duration of sensory block by 56 minutes, which was highly significant. The extended duration of anesthesia can have several unintended consequences such as extending stay in the post anesthesia recovery unit (PACU), impairing mother and baby bonding, and utilizing healthcare resources as nurses have to stay with the patient longer limiting the ability to complete another elective CD. Recognizing the perioperative movement towards adopting ERAS strategies, dexamethasone will be a routine adjunct to prevent spinal associated nausea and vomiting. Formally quantifying the effect IV dexamethasone has on spinal anesthesia for CD will help anesthesia providers decide whether to administer IV dexamethasone intraoperatively. For example, if providers are hoping to extend the length of the spinal blockade (prolonged surgical duration) they could choose dexamethasone as the second multi-modal antiemetic. Alternatively, anesthesia providers could omit IV dexamethasone, and use an alternative anti- emetic such as metoclopramide, to promote rapid discharge from the PACU, improving perioperative efficiency and health utilization. The investigators hypothesize that in healthy parturients having elective CD, 10 mg IV dexamethasone will increase the duration of motor blockade from spinal anesthesia using 0.75% bupivacaine, lengthening the time spent in PACU. Design \& Procedure: This is a randomized double-blind controlled clinical trial in non-laboring parturients presenting for elective CD. The spinal anesthesia technique will be standardized and will be administered as per routine care at IWK Health. Each patient will receive 12 mg of 0.75% hyperbaric bupivacaine with 10 micrograms of fentanyl and 100 micrograms of epidural morphine via a 25-gauge Whitacre spinal needle. Computer generation will randomize patients to either Group SD, who will receive IV dexamethasone 10 mg (1mL), or group SM who will receive IV metoclopramide 10 mg (2 mL) (alternative anti-emetic), immediately after spinal anesthesia by the attending anesthesia provider. Additionally, each patient will receive ondansetron 4mg IV, immediately after spinal anesthesia (second anti-emetic as recommended for ERAS protocol). If a third anti-emetic is required for ongoing nausea and vomiting in the operating room or PACU, dimenhydrinate 12.5- 25 mg IV can be provided for both groups. If a fourth anti-emetic is required for ongoing nausea and vomiting in the operating room or PACU, haloperidol 0.5mg IV can be provided for both groups. All anti-nausea medications administered will be tracked on the data collection record (DCR). The randomization assignments will be placed in a sealed envelope by a research staff member who is not participating in clinical data collection. The randomization log will be kept in a secure/locked research office. The randomization envelope will be provided to the attending anesthesiologist by a research team member on the morning of surgery. All drugs will be prepared and administered by the attending anesthesiologist, who will not be blind. The patient and research team assessor will be blinded to treatment allocation. Sensation will be tested using ice and quality of motor block will be assessed using modified Bromage score. In PACU, research personnel, unaware of the subject's randomization, will assess motor blockade unilaterally every 15 minutes until a Bromage score of 3 is present. That time will be entered on the DCR, and the patient will be assessed more frequently (every 3-5 minutes) until a Bromage of 4 is achieved and confirmed bilaterally with a second assessment 1-minute later. If needed, assessments will continue to occur every 3-5 minutes until a Bromage score of 4 is reached bilaterally. Sensation will be assessed every 15 minutes unilaterally. When sensation is reached at L3, a bilateral assessment will be taken, and the time will be recorded. If needed, assessments will continue to occur every 15 minutes. The time will be recorded on the DCR when sensation at L3 is reached bilaterally. Numeric Rating Scale (NRS) scores for pain and nausea intensity will be collected every hour postoperatively until a Bromage score of 4 is achieved. The time of opioid use and total opioid dose in the first 24 h will be recorded during the PACU stay and from medical chart review. The incidence of pruritus (itching) and vomiting will also be assessed prior to PACU discharge. Data Analysis: In keeping with CONSORT guidelines, all subjects enrolled will be included in an intention to treat analysis. Descriptive statistics will be expressed as mean +/- standard deviation. Demographics (height, weight, etc.) will be analyzed using Student's t-test. Nonparametric testing (Mann-Whitney U test) will be used to evaluate NRS pain scores, opioid consumption and sensory and motor duration. Categorical data (nausea and vomiting) will be analyzed using the x2 test or Fisher's exact test, as appropriate. The investigators will perform the statistical analysis with the assistance of the consulting departmental statistician. With power of 90% and confidence interval of 95% (α = 0.05), a clinically meaningful change in recovery time of 15 minutes with a (generous) anticipated standard deviation of 33, 116 participants are required (58 per group). It is anticipated that the standard deviation could be smaller than this, which would mean that the investigators could be powered to detect a 15-minute difference at α = 0.05 with fewer than 116 participants. 116 is a conservative estimate to ensure that the investigators have the power needed to test the primary hypothesis.

Annually, approximately 400 anatomical resections (lobectomy and segmentectomy) are performed using video-assisted thoracoscopic surgery (VATS) at the Department of Cardiothoracic Surgery, Rigshospitalet. Tissue damage occurs during surgery, triggering an inflammatory response.Glucocorticoids, including Dexamethasone, administered in relation to surgery, have shown anti-inflammatory effects in previous studies and the potential to reduce postoperative pain and hospitalization duration in various surgical procedures. Previous studies have indicated that the most common complications of VATS lobectomy leading to prolonged hospitalization in patients are air leakage (27%), pneumonia (20%), and pain (15%). A previous study from Rigshospitalet, Denmark found that half of the patients undergoing a VATS lobectomy, reported severe pain (defined as Numeric Rating Scale (NRS) ≥ 5) at some point on the day of surgery and first postoperative day. This indicates a need for better pain management following VATS lobectomy, which is confirmed by another study Rigshospitalet, Denmark that found a high rate of severe pain (NRS \> 5) in the first two days after a VATS lobectomy. The median NRS score when coughing on the morning after surgery was 6.0 (5.0-8.0). Improved pain management is expected to facilitate easier mobilization, likely resulting in fewer pulmonary complications and shorter hospital stays. The Pain Catastrophizing Scale (PCS) is a self-assessment questionnaire examining catastrophic thinking in relation to pain. The PCS score has previously been shown to correlate with postoperative pain, and in another study found that increasing scores of PCS resulted in higher pain scores, and that patients grouped as "High-pain-responders" (PCS≥20) had significantly more pain when coughing on the first postoperative day. Previous studies, in patients undergoing a total knee arthroplasty, showed that higher doses of Dexamethasone reduced the percentage of patients experiencing moderate-severe pain postoperatively in the "High-pain-responder" group, however not in the "Low-pain-responder" group. The aim is to conduct a randomized controlled trial (RCT) with a high dose arm (1mg/kg) vs a low dose (8mg in total) of steroid (Dexamethasone) given intravenous (IV) after the induction of anesthesia to "High-pain-responders" in patients undergoing VATS lobecto-my/segmentectomy. Safety of higher doses of glucocorticoid has previously been extensively examined and side effects are considered negligible, and several larger meta-analyses of previous studies have only minor side effects with glucocorticoids in both low and high doses when compared to placebo. Previous studies have also performed exactly the same intervention, with same doses of Dexamethasone, in patients scheduled for knee and hip arthroplasty without any safety issues. The hypothesis is that a high dose of Dexamethasone can lower pain when coughing in th morning after VATS lobectomy/segmentectomy, in patients scoring as "High-pain-responders" on the Pain-Catastrophizing-Scale