Background:Major surgical procedures, such as gastrectomy, result in extensive postoperative pain, which can lead to increased morbidity, discomfort and dissatisfaction among the patients.Objectives:The aim of this study was to evaluate the effect of adding diclofenac suppositories or intravenous paracetamol, on morphine consumption and on the quality of postgastrectomy pain control.Patients and Methods:This randomized double blinded clinical trial was carried out in 90 patients with gastric cancer, who were candidates for gastrectomy, which were divided into three similar groups. The patients were transferred to an intensive care unit after the operation and received patient-controlled analgesia (PCA) with morphine, morphine PCA plus intravenous paracetamol 1 g, every 6 hours, and morphine PCA plus diclofenac suppositories, 100 mg every 8 hours. The patients were evaluated for up to 24 hours after the operation for the severity of pain, alertness, and opioid complications.Results:There was no significant difference in pain scores among the three groups (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hours were 0.72, 0.19, 0.21, 0.66, 0.54, 0.56, and 0.25, respectively), although morphine consumption was greater in the morphine group, compared with the other two groups (21.4 ± 7.7 mg in morphine group vs. 14.3 ± 5.8 mg in morphine-paracetamol group and 14.3 ± 3.9 in morphine-diclofenac group; P = 0.001). In morphine group, during the first 24 hours, the patients had lower levels of consciousness (P values, after extubation, at 2, 4, 6, 12, 18 and 24 hour were 0.6, 0.95, 0.28, 0.005, 0.027, 0.022 and 0.004 respectively), even though the incidence of complications was similar among the three groups.Conclusions:In this study, intravenous paracetamol or diclofenac suppositories, administered for postgastrectomy pain control, decreased morphine consumption by almost 32% and also improved alertness. Nevertheless, the amount of opioids did not affect the incidence of complications.

Purpose: Conflicting results exist regarding the efficacy of N-acetyl cysteine (NAC) in sepsis treatment. A pivotal factor affecting the therapeutic potency of NAC in sepsis is timing and dosing of its infusion. We aimed to assess the effect of NAC on redox status of patients with sepsis and to compare its efficacy in intermittent and continuous infusion with the objective of developing the infusion regimen and optimizing the timing. Materials and Methods: A prospective, randomized clinical trial was designed to compare the antioxidative effect of NAC in intermittent infusion group (IV: 25 mg/kg bolus and then 25 mg/kg/8 hours 3 times) and continuous infusion group (IV: 25 mg/kg bolus and then 75 mg/kg over 24 hours) in 60 critically ill patients with sepsis (20 patients in each group). Blood samples were collected immediately before and after intervention for total antioxidant capacity (TAC) and malondialdehyde (MDA) assessment. Results: N-acetyl cysteine considerably increased TAC levels in both intermittent (0.68 ± 0.60; P value = .036) and continuous (0.69 ± 0.64; P value = .015) infusion groups when compared to placebo (0.61 ± 0.10); however, the difference in TAC levels between the intermittent and the continuous infusion did not reach statistical significance ( P value = .942). Likewise, NAC treatment decreased MDA levels in both intermittent (19.45 ± 4.18; P value = 0.001) and continuous (22.47 ± 6.68; P value = .002) infusion groups when compared to placebo (31.76 ± 11.06), while the difference in MDA levels between the intermittent and the continuous infusion did not reach statistical significance ( P value = .481). Conclusion: Our data confirmed the antioxidative effect of NAC treatment in patients with sepsis, with no significant difference in intermittent and continuous infusion.

The antiviral effectiveness of allicin (L-cysteine) has been shown by numerous studies in both levels of clinical and animals. The aim of this study was to evaluate the therapeutic effect of allicin (L-cysteine) on clinical presentation and prognosis. In the current study, 66 patients with COVID-19 based on clinical, radiological presentations and RT-PCR results, were enrolled in two groups of placebo and allicin. In the both allicin (L-cysteine) and placebo groups (n=33 in each group), the capsules were prescribed two times a day for two weeks. Clinical signs and symptoms, blood parameters and chest CT scan were evaluated before and two weeks after treatment. The results showed that allicin (L-cysteine) could significantly impact on improvement of signs and symptoms of COVID-19 after two weeks of treatment in comparison to placebo. Allicin (L-cysteine) not only improve the clinical signs, but also ameliorate the lab and radiological data, which suggest a therapeutic effect for this agent in COVID-19. Our data suggest the therapeutic effect of allicin (L-cysteine) on COVID-19 through improvement of clinical symptoms and acceleration of the healing process.

Background: Magnesium sulfate has been used in different studies as a pain control agent; however, the results are contradictory. This study aimed to evaluate the effect of magnesium sulfate on postoperative pain management during abdominal surgery. Methods: This randomized double-blinded study involved 84 patients candidates for abdominal surgery, who were divided into two groups (42 patients in each group). In the magnesium group, 25 mg/kg magnesium sulfate was infused for 1 h; then, 100 mg/kg/24 h was infused in the intensive care unit. The patients’ pain intensity, which was the primary outcome, was assessed using the numeric rating scale (NRS) every 3 h. If the NRS was > 3, morphine was used and evaluated as a secondary outcome after 24 h. The patients and nurses who assessed the patients were blinded to the drug groups. The results were analyzed using SPSS ver. 19 software, and statistical significance was set at P < 0.05.Results: Age, sex, body mass index (BMI) and surgery duration were similar between the groups. The pain intensity was 4 ± 0.2 in the control and 3.8 ± 0.2 in the magnesium group at first and then 3.98 ± 0.2 in the control and 3.45 ± 0.2 in the magnesium group at the third hour, which were similar in both groups (P = 0.39 and P = 0.17, respectively), but thereafter between 6 and 24 h, the pain severity was significantly lower in the magnesium group (4.4 ± 1.3 in the control and 3.34 ± 1 in the magnesium group at 6th hour and P = 0.001). In addition, morphine intake in the first 24 h in the two groups had a significant difference, with 13.2 ± 5.7 in control group and 8 ± 3.5 in magnesium group (P = 0.001). Hemodynamic state and muscle relaxation were similar in both groups.Conclusions: In this study, intravenous magnesium sulfate after abdominal surgeries for 24 h resolved the pain intensity after six hours and reduced morphine dosage.

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