Pre-operative rectal indomethacin for reduction of postoperative nausea and vomiting after laparoscopic cholecystectomy: a double-blind randomized clinical trial

OBJECTIVE: To evaluate the effect of pre-operative indomethacin suppository on postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. STUDY DESIGN: A double blind placebo-controlled randomized clinical trial. PLACE AND DURATION OF STUDY: Hazrat Rasoul Akram Hospital, Tehran, Iran, from February 2010 to September 2012. METHODOLOGY: One hundred and thirty patients, scheduled for laparoscopic cholecystectomy, were randomly divided into case and control groups. Sixty-five patients received indomethacin suppository and 70 patients received rectal placebo in the case and control groups respectively. All patients underwent the same protocol in laparoscopic surgery and anesthesia, then nausea and vomiting was recorded after 1, 6, 12 and 24 hours postoperatively and compared between the two groups. Independent-sample t test or Mann-Whitney tests were used for statistical analysis. Level of statistical significance was set at P ² 0.05. RESULTS: Patients' nausea was statistically lower in the case group at the 1st hour (43.1 vs. 92.9), 6th hour (20.0 vs. 68.6) and 12th hour (7.7 vs. 24.3) after surgery (for all periods, P < 0.001). Fewer patients in the case group experienced vomiting at the first (13.8 vs. 51.4) and 6th hour (0 vs. 20) after surgery (for both P < 0.001). The use of pethidine was also statistically less in the case group in the same hours after surgery (for all of them, P < 0.001). CONCLUSION: Rectal indomethacin before laparoscopic cholecystectomy led to lower postoperative nausea and vomiting

Health concerns of various nanoparticles: A review of their in vitro and in vivo toxicity

Nanoparticles (NPs) are currently used in diagnosis and treatment of many human diseases, including autoimmune diseases and cancer. However, cytotoxic effects of NPs on normal cells and living organs is a severe limiting factor that hinders their use in clinic. In addition, diversity of NPs and their physico-chemical properties, including particle size, shape, surface area, dispersity and protein corona effects are considered as key factors that have a crucial impact on their safe or toxicological behaviors. Current studies on toxic effects of NPs are aimed to identify the targets and mechanisms of their side effects, with a focus on elucidating the patterns of NP transport, accumulation, degradation, and elimination, in both in vitro and in vitro models. NPs can enter the body through inhalation, skin and digestive routes. Consequently, there is a need for reliable information about effects of NPs on various organs in order to reveal their efficacy and impact on health. This review covers the existing knowledge base on the subject that hopefully prepares us better to address these challenges. © 2018 by the authors. Licensee MDPI, Basel, Switzerland

Management of Sigmoid Volvulus Avoiding Sigmoid Resection

Acute sigmoid volvulus is typically caused by an excessively mobile and redundant segment of colon with a stretched mesenteric pedicle. When this segment twists on its pedicle, the result can be obstruction, ischemia and perforation. A healthy, 18-year-old Caucasian woman presented to the emergency department complaining of cramping abdominal pain, distention, constipation and obstipation for the last 72 h, accompanied by nausea, vomiting and abdominal tenderness. The patient had tympanitic percussion tones and no bowel sounds. She was diagnosed with acute sigmoid volvulus. Although urgent resective surgery seems to be the appropriate treatment for those who present with acute abdominal pain, intestinal perforation or ischemic necrosis of the intestinal mucosa, the first therapeutic choice for clinically stable patients in good general condition is considered, by many institutions, to be endoscopic decompression. Controversy exists on the decision of the time, the type of definitive treatment, the strategy and the most appropriate surgical technique, especially for teenagers for whom sigmoid resection can be avoided

Real time voltage stabilization in microgrid

This study suggests a new algorithm based on a combination of fuzzy logic and genetic algorithm (GA) to improve voltage profile in a microgrid. The considered microgrid includes control variables such as onload tap changer (OLTC), active power output from distributed generators (DG) and reactive power output from feeder switched capacitors that are controlled in a microgrid controller (MGC) by communication links. The proposed method was used to obtain the optimum value of control variables to establish voltage stabilization in varying load condition as online. For establishing voltage stabilization at the microgrid, an objective function is defined and is tried to minimize it by control variables. The control variables were changed based on fuzzy logic and the GA was employed for finding the optimum shape of membership functions. In order to verify the proposed method, a 34 buses microgrid in varying load condition was analyzed and was compared with previous works

Effects of preoperative administration of ginger (Zingiber officinale Roscoe) on postoperative nausea and vomiting after laparoscopic cholecystectomy

One of the most common postoperative problems is nausea and vomiting. Although using some anesthetic materials has been considered as the mainstay of this phenomenon, the exact factors are not known. Because of several morbidities associated with postoperative nausea and vomiting (PONV), its prevention and treatment has been a challenge for physicians, so several drugs have been recommended for this purpose. Based on the documented antiemetic specificity of ginger, we evaluated and compared the effects of preoperative administration of ginger on PONV with ondansetron administration as the standard medication. The participants included 100 patients with cholelitiasis who were candidate for laparoscopic cholecystectomy. Patients were divided into two groups: group A comprised 50 patients who received 500 mg oral ginger 1 h before surgery, and group B included 50 patients who received 4 mg intravenous ondansetron before completion of surgery. Antiemetic efficacy was assessed by visual analogue scale scores of nausea intensity at 0, 4, 8, 16, and 24 h after surgery and frequency of vomiting during the evaluation period. Although multifactor analysis showed that nausea severity was significantly lower in the ginger group, the data indicated that except 16 h after operation, the differences between two groups in the frequency of vomiting was not significant. In conclusion, though complementary studies are needed to have a strong suggestion, based on this study, we recommend administration of oral ginger 1 h before operation to control the severity of PONV in patients undergoing laparoscopic cholecystectomy. Keywords: Ginger (Zingiber officinale Roscoe), Postoperative nausea and vomiting, Cholecystectomy, Laparoscopi

Management of Severe Perineal Injuries in Major Pelvic Fractures

Introduction: Significant perineal injuries and major pelvic fractures resulting from blunt trauma manifest a high-energy injury. Open pelvic fractures (with perineal injury) are associated with higher mortality rates of 40 to 60 %. Methods: This study was a review of patients with multiple traumas comprising of major pelvic fracture and severe perineal injuries (Shahid Kamyab hospital in Mashhad from 2002- 2005). A total of 11 patients, with pelvic fracture and perineal injuries (injury to urethra and anal canal) were entered in the study. The data was gathered by a checklist and analyzed with SPSS software. Results: The population under study included 11 patients (9 male, 2 female) with a mean age of 35years. Cause of trauma in all patients was motor vehicle accidents. All of the patients in the first 6 hours of admission received at least 4 liters of serum ringer lactate and 3 units of packed cells. The mean of packed cell received was 8 units and one patient needed 21 units of packed cells. All of patients were taken to the operating room for diverting colostomy, distal rectal washout, cystostomy and radical debridment and irrigation of devitalized tissue. Good results were achieved in 9 patients and there was one case of mortality and one morbidity (ARF). Conclusion: Open pelvic fractures and perineal injuries are associated with higher mortality rates. Prompt diagnosis and proper treatment (reanimation, colostomy, cystostomy, debridment and irrigation) is the key to success

Tension pneumothorax in patient with COVID-19 infection

Corona-virus infection that arose from China is now a global pandemic. It presents with a variety of pulmonary manifestations, most commonly in the form of ground glass pulmonary lesions and opacities. Less common manifestation such as pnuemothorax has been reported by some authors. In this study we report a 56-year-old man with Corona-virus disease presenting with tension pneumothorax, a rare and life-threatening complication of Corona-virus infection that has not been reported previously. In our case, after insertion of thoracostomy tube, the patient's symptoms improved. After about 1 year of Corona-virus pandemic, it still presents with some rare pulmonary and extrapulmonary manifestations, so, familiarity with these manifestations is important for a correct diagnosis and treatment. © 202