Background We aimed to compare the efficacy of nebulized hypertonic (3%, 5% and 7%) saline with normal saline in hospitalized infants with acute bronchiolitis. Materials and Methods In this triple-blinded randomized clinical trial, 120 children with moderate to severe bronchiolitis randomly assigned into four groups to receive nebulized normal saline (group A), saline 3% (group B), saline 5% (group C), and saline 7% (group D). The length of hospital stay (LOS) as primary outcome and the use of oxygen, temperature, oxygen saturation (SPO2), pulse rate (PR), respiratory rate (RR), and bronchiolitis severity score were measured in the beginning of the study and during hospitalization. Results The mean age of patients was 5 + 0. 423 months and 79 of them (65%) were male. The length of hospital stay (LOS), and use of oxygen supplementation was not different between group A and B (P=0. 36), but significantly lower than group C and D (P<0. 001). Vital signs, improvement in severity score and oxygen saturation were similar between groups. Conclusion Our study demonstrated that nebulization with 3% hypertonic saline and 0. 9% saline can significantly reduce hospitalization rate compared nebulization with 5% and 7% hypertonic saline.

Background: One of the most prevalent procedures involving general anesthesia (GA) is endotracheal intubation, which can lead to a variety of airway complications. Patients undergoing GA with tracheal intubation may experience a common complication, known as postoperative sore throat (POST). We conducted this study to assess and compare the effectiveness of preoperatively administered nebulized ketamine and dexmedetomidine in alleviating POST. Methods: We randomly divided the patients into two groups, each containing 151 patients. Group-K patients were nebulized with 50 mg (1 ml) with 3 ml normal saline, while Group-D patients were nebulized with dexmedetomidine 50 mcg (0. 5 ml) with 3. 5 ml normal saline, preoperatively. GA was administered 15 min post-nebulization. POSTwas graded at 4, 6, 12, and 24 h after extubation on a four-point scale (0-3). The statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS) software version 17. 0. Results: In the present study, the overall incidence of POST was 32. 5%. among which 39 patients (25. 8%) in the ketamine group and 59 patients (39. 1%) in the dexmedetomidine group experienced POST at 4h, following extubation (P value=0. 014). A significantly higher incidence of POST in the dexmedetomidine group was noticed as compared to the ketamine group (P value < 0. 05). But, at 6h, 12h, and 24h, the difference was not statistically significant between the two groups. A significantly larger percentage of cases in the dexmedetomidine group had more severe POST than in the ketamine group, at 4h following extubation (p-value <0. 05). There was no significant rise in systolic and diastolic blood pressure in either group. However, the ketamine group had a significantly higher mean heart rate after extubation compared to the dexmedetomidine group. Conclusion: Ketamine nebulization significantly decreases the incidence and severity of postoperative sore throat during the early postoperative period with minimum hemodynamic changes

Background: Previous investigations have indicated the potential of mesenchymal stem cell (MSC) transplantation in treating COVID-19. However, the limited lifespan of transplanted cells constrains this therapeutic approach. the immunomodulatory, anti-inflammatory, and regenerative properties of MSCs secretome could be a promising solution to improve patient outcomes. Materials and Methods: A randomized clinical trial was conducted in Kerman, a region in south-central Iran. This study enrolled twenty patients in the severe phase of COVID-19 pneumonia, randomly allocated into either investigation or control groups. Both groups received standard therapy, the investigation group additionally received nebulized concentrated MSCs secretome, 2 mL administered twice daily for five consecutive days. To evaluate the effect of MSCs secretome therapy, the length of stay in the intensive care unit (ICU), oximetry, and paraclinical results were assessed at baseline and 5 days after ICU admission. Results: Baseline characteristics were balanced and distributed among the two groups. No adverse effect was observed in MSCs secretome-treated patients. Compared to the control group, the investigated group exhibited a decrease in ICU stay duration (10. 90 ± 3. 75 vs. 5. 50 ± 1. 64 days, P = 0. 04) and a significant improvement in O2 saturation (60. 65 ± 16. 58 vs. 79. 47 ± 15. 36, P = 0. 02). In addition, significant decreases in CRP, PTT, and INR and upregulation in lymphocyte fraction were observed in the investigation group during the study period. Conclusions: The findings of this study underscore the prospective advantages and safety of the secretome of MSCs as a viable therapeutic choice in COVID-19 patients. We advise verifying our results through additional clinical trials at various disease stages.

This study aimed to explore the underlying mechanism of nebulized dexmedetomidine (DEX) in ameliorating ventilator-induced lung injury (VILI)-induced oxidative stress in rats. Forty 7 to 8-week-old Sprague-Dawley rats at the specific pathogen-free level were randomized into the control group, model group, nebulized dexmedetomidine (WH-YM) group, and dexmedetomidine intravenous infusion (JM-YM) group, each containing 10 rats. Except for the control group, rats in the other groups underwent mechanical ventilation (tidal volume,  40 mL/kg; respiratory rate, 70 breaths per minute; inspiratory-to-expiratory ratio, 1:2; fraction of inspired oxygen, 21%; positive end-expiratory pressure, 0 cmH2O). Nebulized DEX (6.3 µg/kg), and isodose intravenous DEX  were given to rats of WH-YM and JM-YM groups prior to ventilation. Post 4-hour ventilation, rats were euthanized. Lung tissue wet-to-dry weight ratio, H&E staining for assessing diffuse alveolar damage (DAD), and expression levels of Nrf2 and Keap1 detected by qRT-PCR and Western blot were compared. Inflammatory markers TNF-α, IL-2, and IL-6, and oxidative stress indices malondialdehyde (MDA) and superoxide dismutase (SOD), were quantified in lung tissues and serum samples using commercial kits.  Rats in the WH-YM and JM-YM groups demonstrated significant ameliorations in the wet-to-dry weight ratio and DAD score, decreased Keap1, TNF-α, IL-2, and IL-6 levels in lung tissues and serum samples, but increased Nrf2 and SOD level than those of controls. These changes were more pronounced in the WH-YM group than in the JM-YM group. DEX effectively alleviates VILI-induced oxidative stress and inflammation via the Keap1-Nrf2-ARE signaling pathway., especially in the nebulized administration.

Objective (s): Abdominal adhesions are one of the most important problems, occurring after intra-abdominal surgery in more than 90% of cases. This condition is the leading cause of bowel obstruction, infertility, and abdominal/pelvic pain. Gold nanoparticles (GNPs) have been shown to be non-toxic and exhibit anti-inflammatory, anti-angiogenic and antioxidant activities. The purpose of this study was to determine the effect of intraperitoneal lavage with GNP solutions on the development of postoperative peritoneal adhesion (PPA).Materials and Methods: In the current experimental study, thirty-five male Wistar rats were randomly assigned to seven groups of five rats. After a standardized peritoneal injury, GNP solutions in different concentrations (1, 2.5, 5, 10, 50 and 100 ng/ml) were locally administered through nebulization; normal saline (NS) was administered to the control group. Two weeks later, the rats were sacrificed and cecum and peritoneal samples were harvested for histopathological assessment. Blood samples were obtained to determine serum concentrations of inflammatory biomarkers including tumor necrosis factor alpha (TNF-a), interleukin-1 beta (IL-1b) and vascular endothelial growth factor (VEGF).Results: The rats treated with GNPs had significantly lower microscopic and macroscopic peritoneal adhesion scores, compared to the control group (P<0.05). Score 5 of macroscopic adhesions was reported in all the rats of the control group, unlike the GNP groups. Furthermore, microscopic adhesions were reported with all rats in the control group, unlike the GNP groups (reported in 0 out of 5 rats in all GNP groups). In addition, serum levels of IL-1b, TNF-a and VEGF underwent no significant changes.Conclusion: Compared to the control group, GNPs decreased the severity of peritoneal adhesions, although they did not alter TNF a, IL-1b or VEGF serum levels.

Background Bronchiolitis is the commonest cause of lower respiratory tract infection in infant. Respiratory syncytial virus is the commonest cause of bronchiolitis. This study aimed to assess the efficacy of nebulized 3% hypertonic saline and salbutamol in the treatment of acute bronchiolitis in comparison with nebulized 0. 9% saline and salbutamol. Materials and Methods A prospective case second multicenter study was done at two pediatric tertiary centers at the period from 1st of December 2014 to 31 of March 2015. A total of 100 previously well infant and children of age 1-24 months with clinical diagnoses of bronchiolitis who were admitted to the hospital were included. They were divided into two groups, the study group received 4 ml of nebulized hypertonic 3% saline (for 14 days), and second group received 4 ml of nebulized normal 0. 9% saline (for 14 days), each co-administer with 0. 5 ml salbutamol. Results All patients with acute bronchiolitis having similar baseline characteristic, mean age 4. 9 + Standard deviation (SD) months, male gender constitutes 68% of the patients and the majority (67%) of the cases were below 6 months. The mean of clinical severity score at admission was 6. 4 for normal saline (NS) group and 6. 6 for hypertonic 3% saline (HS) group. The mean length of hospital stay of normal saline group = 4. 3 + Standard deviation (SD) day and for hypertonic saline group was = 4. 7 + Standard deviation (SD) day. Conclusion We didn’ t find any advantage of hypertonic 3% saline over 0. 9% normal saline in terms of length of hospital stay and clinical severity score.

Post-operative sore throat (POST) is the consistent undesirable problem following general anesthesia. Various methods have been tried out to overcome the same. Many studies have proved ketamine to be one of the drugs in POST reduction. This study proposed to establish the efficacy of ketamine administered as gargle and nebulization in reducing the POST incidence in patients receiving general anesthesia with orotracheolaryngeal intubation. 100 adults were randomly assigned into two groups. Adults in group A (n=50) subjected to nebulization with ketamine 50 mg for 15 minutes and patients in group B (n=50) were subjected to gargle with ketamine 50 mg for 40 seconds. In both groups, all patients were intubated by an experienced anesthesiologist. After extubation, we assessed them for the occurrence and severity of POST at regular intervals. The POST incidence at the 0th, 1st, 2nd, 4th, 6th, 8th, 12th, and 24th hours was 14%, 12%, 24%, 42%, 40%, 24%, 16%, and 10% in ketamine nebulization group and 18%, 34%, 58%, 50%, 46%, 38%, 30%, and 16% in ketamine gargle group, respectively. The p-value at the 1st hr was statistically high with the occurrence of POST being lower in nebulization group. The overall occurrence with POST severity, both were lower in the ketamine nebulization compared to ketamine gargle group. Ketamine nebulization is an effective method for reducing POST than ketamine gargle, in the initial period after surgery.

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive fatal disease affecting the lung, and currently there is no efficient therapy for this condition. Curcumin, as a natural anti-inflammatory and antioxidant agent, could repress the pulmonary fibrosis (PF) caused by Bleomycin (BLM). Objectives: The aim of the research was to evaluate the protective activity of a nano-formulation of curcumin administered by inhalation on BLM-induced PF in rats. Methods: Eighty rats were randomly divided into eight experimental groups. Group one (control) that received saline intratracheally (IT) and subjected to vehicle inhalation. Group two to eight each received a single dose of BLM (5 IU/kg, IT) along with vehicle inhalation, oral prednisolone, oral curcumin, curcumin inhalation, and nano-curcumin inhalation with the doses of 50, 100, and 200 µ g/kg, respectively. In the control and other groups, BLM was injected intratracheally on the first day of the experiment. In the treatment groups, curcumin suspension was prepared in distilled water and applied through nebulization for 21 consecutive days after BLM intratracheal administration. Then the rats were euthanized, and inflammatory cytokines (TNF-α , TGF-β , PDGF), hydroxyproline, and IL-10 (as a protective cytokine) were measured. Also, lung histopathological features were examined. Results: The synthesized nano-formulation reduced the overall hydroxyproline content of lungs in BLM-treated rats (P < 0. 002). In addition, TNF-α , TGF-β , and PDGF levels significantly increased in the lungs of BLM-instilled rats (P < 0. 001). However, the nano-formulation of curcumin (200 µ g/kg) significantly decreased the levels of these inflammatory cytokines (P < 0. 001) and increased IL-10 level (P = 0. 0144) compared with the control group. Conclusions: The nebulization of nano-curcumin is suggested as a novel approach for the treatment of PF induced by BLM in rats. Our findings revealed that the inhalation (as a safe local drug delivery system approach) of the nano-curcumin at a dose of 200 µ g/kg (formulated by cyclodextrin) could effectively protect the lung against PF.