Efficacy of Granisetron versus Sufentanil on Reducing Myoclonic Movements Following Etomidate: A double-blind, randomized clinical trial

Objective: Etomidate-induced myoclonus occurs in up to 85% of patients under general anesthesia. This type of myoclonus can induce significant clinical and economic problems in patients with special conditions. Hence, to reduce the intensity of myoclonus movements, the present study was conducted to compare the effectiveness of granisetron and sufentanil on reducing the intensity of etomidate-induced myoclonic movements. Methods: This double-blind randomized clinical trial study consisted of 96 adult patients. Using block randomization, subjects were divided into three groups of 32: the group receiving granisetron 40 μg / kg (group G), the group receiving sufentanil 0.2 μg / kg (group S), and the control group who did not receive the pretreatment (group C). Patients received these medications as pretreatments 120 seconds before induction with etomidate. After injection of etomidate with a dose of 0.3 mg/kg, the incidence of myoclonus was evaluated. After evaluating the myoclonus, the full dose of narcotics (fentanyl 1 μg / kg) and muscle relaxants (atracurium 0.5 mg/kg) were administered to patients, and a suitable airway was established for them. Results: The findings indicated that granisetron reduced the intensity and incidence of myoclonic movements more than sufentanil. In addition, myoclonic movements were observed at a significantly higher intensity in the control group (P=0.001). Conclusion: The results obtained from the current study indicate that granisetron and sufentanil as pretreatments are effective for reducing myoclonus in patients. Keywords: Granisetron; Sufentanil; Etomidate; Myoclonus; Movement

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Non-invasive hemodynamic monitoring in critical care units: Review article

ABStRAct Aims and backgrounds : Hemodynamic monitoring of critical patients in intensive care units is the cornerstone of care. It constitutes an extensive part of care and is helpful in determination of the causes and the response to treatment of hemodynamic instability. The aim of this review article is to evaluate non invasive hemodynamic monitoring in critical care units. Materials and Methods: 61 articles were allocated to this study with the time frame covered from 1890 to 2010. The references of this review article were obtained from Pubmed, Elsevier, Google scholar, Elsevier mason, Science direct, and JAMA. The authors have also used the keywords including: cardiac output, non-invasive, intensive care unit, oxygenation, upstream, downstream markers,hemodynamic monitoring, minimally invasive methods, and circulatory shock. Findings: The results of this study show that the desirable and premium monitoring of serious patients in intensive care units have yet remained as a challenge. Awareness of cardiac output which is the most important indicator of cardiac function is of vital importance for deciding on the method of clinical management, selecting treatment method, clinical assessment, and prognosis of the patients suffering from cardiac problems. conclusions: A lot of such studies show that the Non-invasive monitoring system of cardiac output is easier, safer, cheaper, and more effective than the invasive monitoring system .If this method is used properly,it could reduce the mortality and morbidity rate

The Effect of Using Olive Oil and Fish Oil Prophylactic Dressings on Heel Pressure Injury Development in Critically Ill Patients

Introduction and Aim: Prevention of pressure injuries in patients hospitalized in intensive care units is significantly important. Therefore, in the present study, the effect of using olive oil and fish oil prophylactic dressings on the development of heel pressure injuries was investigated. Methods: The present study was a clinical trial conducted in the intensive care unit of Shahid Beheshti Hospital, in Yasuj. Fifty patients, who were at moderate to high risk of pressure injuries development, were randomly divided into two groups based on the mean score of the Braden scale. In one group, patients’ heels were dressed using olive oil prophylactic dressing, and in the other group, patients’ heels were dressed using fish oil prophylactic dressing. The dressings were changed 3 times a day. Collected data were then analyzed using SPSS v16. Results: No significant difference was determined in demographic variables among the two groups (p<0.05). In terms of the development of heel pressure injuries, none of the patients in the olive oil and fish oil groups had pressure injuries. Conclusion: There were no statistically significant differences in either treatment group related to heel pressure injuries outcomes during the 7 days observed in the study. Additionally, both dressings had the same effects. Further studies are recommended in this regar

TheEffectofUsingOliveOilandFishOilProphylactic Dressings on Heel Pressure Injury Development in Critically Ill Patients

Introduction and Aim: Prevention of pressure injuries in patients hospitalized in intensive care units is significantly important. Therefore, in the present study, the effect of using olive oil and fish oil prophylactic dressings on the development of heel pressure injuries was investigated. Methods: The present study was a clinical trial conducted in the intensive care unit of Shahid Beheshti Hospital, in Yasuj. Fifty patients, who were at moderate to high risk of pressure injuries development, were randomly divided into two groups based on the mean score of the Braden scale. In one group, patients’ heels were dressed using olive oil prophylactic dressing, and in the other group, patients’ heels were dressed using fish oil prophylactic dressing. The dressings were changed 3 times a day. Collected data were then analyzed using SPSS v16. Results: No significant difference was determined in demographic variables among the two groups (p<0.05). In terms of the development of heel pressure injuries, none of the patients in the olive oil and fish oil groups had pressure injuries. Conclusion: Therewerenostatisticallysignificantdifferencesineithertreatmentgrouprelated to heel pressure injuries outcomes during the 7 days observed in the study. Additionally, both dressings had the same effects. Further studies are recommended in this regard

Factors responsible for spoilage, drawbacks of conventional packaging, and advanced packaging systems for tomatoes

Tomatoes are cultivated and consumed in almost all countries of the world, highly valued for the abundance of nutritional compounds that contribute to their sweet-sour taste, widely appreciated globally. The unique taste of tomatoes is attributed to the volatile compounds and nutrition components, including acids, sugars, lipids, pigments, alcohols, aldehydes, ketones, esters, and terpenes. As climacteric fruit, tomatoes undergo various pos-harvest changes, and multiple factors contribute to their rapid spoilage, resulting in losse of this perishable commodity. Packaging plays a pivotal role in extending the shelf life of tomatoes and preserving their quality characteristics throughout the supply chain, from the farm to the end consumer. Conventional packaging methods have shown substantial losses, promoting a shift towards new and efficient packaging strategies as indicated by the previous investigations. Recent developments include edible coatings/films, modified atmosphere packaging, active packaging, and nanopackaging, which have proven to be more efficient than conventional methods. These advanced packaging techniques control physicochemical, microbiological, and environmental factors responsible for tomato spoilage, contributing to the reduction of postharvest losses of this valuable fruit