Successful airway management with awake intubation in 40 newborns with tracheoesophageal fistula (TEF)

Introduction: In this retrospective study a review of 40 cases of airway management for newborns with tracheoesophageal fistula (TEF) /esophageal atresia repair is presented. Almost all cases had associated cardiac anomalies.Materials and Methods: Selected management was awake intubation with flow of oxygen via Mapelson F. Sedated awake intubation was performed using Atropine 0.02 mg/kg and Fentanyl1 µg/kg, and then occlusion of the fistula with ligation.Result: In patients with small TEF, there was no problem in intubation and ventilation. Anesthesia management and post operative NICU care was performed for 26 cases with no problem, but in 14 cases there was difficulty for anesthesia management and NICU care. Conclusion: We had no complication with performing the awake intubation technique.

Comparing the effects of ropivacaine and lidocaine associated with epinephrine on the heart rate, blood pressure, and amount of bleeding in patients candidate for cleft palate repair: A randomized clinical trial

Background and aims: This study was conducted to compare the effects of two compounds ropivacaine and lidocaine associated with epinephrine on the heart rate, blood pressure, and bleeding rate in children undergoing general anesthesia for the cleft palate repair surgery. Methods: In this study, 30 children candidates for cleft palate surgery who were referred to Mofid Children’s Hospital, affiliated with Shahid Beheshti University of Medical Sciences in 2021, were included by using the convenience sampling method. The patients were randomly divided into two groups. Group 1 was treated with ropivacaine and group 2 was treated with lidocaine along with epinephrine. The data were analyzed by the SPSS, version 22. Results: In total, no statistically significant difference was found between the two groups in terms of vital signs of blood pressure and heart rate in the 10 stages studied (P<0.05). There was no difference between the two groups in the trend of the changes in blood pressure (P=0.381) and heart rate (P=0.940). However, the trend of blood pressure and heart rate had significantly changed during the study in both groups individually (P<0.001). The bleeding rate (suction) (P<0.001) and the weight of gases used (P=0.003) in the second group were significantly higher than in the first group. Conclusion: No difference was found between the effects of ropivacaine and lidocaine combined with epinephrine on the heart rate and blood pressure in patients who were candidates for the cleft palate surgery, but the rate of bleeding (suction) in the second group was more than the first group. Keywords: Ropivacaine, Lidocaine, Epinephrine, Cleft palate, Heart rate, Blood pressur

Post-operative effects of Oral Midazolam versus Hydroxyzine on Ketamine Intravenously Sedated children

Objectives The aim of this clinical trial was to compare the effects of oral Midazolam with oral Hydroxyzine on post sedation using IV Ketaminein children.Methods This single blind cross over clinical trial, was conducted on 25 children aged 2-6 years of ASA I and definitely negative by Frankl behavioral scale. Participants were divided into two groups: Group I received hydroxyzine syrup premed at the first session and midazolam oral at the 2nd visit. Group II received the premed in the opposite order. Vital signs, were recorded sedation depth, recovery and discharge status and compared potential adverse effects of sedative drugs were checked and recorded including sleepiness, nausea and vomiting, vertigo at 1stand 6th hours of discharge. Collected data were analyzed using SPSS V 20 using Repeated Measures ANOVA and Mann-Whitney tests.Results No significant differences were noticeable between two groups when vital signs, were compared in addition to response to drugs, working time, sleepiness, nausea and vomiting rates. However, there was a significant difference between groups in the incidence of vertigo one hour post operatively with higher prevalence in the Hydroxyzine group. (P=0.022)Conclusion Under the circumstances of this study, no significant difference was found between the two regimen groups, but vertigo was appeared as being higher after the first hour in the Hydroxyzine group

Comparing midazolam-bupivacaine and neostigmine-bupivacaine for caudal anesthesia in children undergoing herniorrhaphy

Introduction: Neostigmine and midazolam are each added to bupivacaine for the purpose of caudal anesthesia. In this study, we compared neostigmine and midazolam, each coadministered with bupivacaine, in terms of analgesia and side effects during pediatric inguinal hernia operations.Material and Methods: We included 60 children 1–6 years-old, candidates for elective unilateral herniorrhaphy. After general anesthesia induction with inhaled sevoflurane, a caudal block was performed. Patients were randomly allocated to one of two trial groups: midazolam group received bupivacaine 25% 1 ml/kg with midazolam 50µg/kg, and neostigmine group received bupivacaine 25% 1 ml/kg with neostigmine 2 µg/kg through the caudal route. Heart rate, mean arterial pressure, and oxygen saturation were recorded before induction and every five minutes after caudal anesthesia up to 30 minutes. Pain and sedation scores were recorded at two, four, six, 12, and 24 hours after the operation, along with rescue analgesia dosage, vomiting, and respiratory depression.Results: Mean duration of analgesia in the midazolam group was similar to the neostigmine group (18.8±9 vs. 20.4±7.5; P= 0.44).The analgesic dosage required was not significantly lower in the neostigmine group compared to the midazolam group (58.3±121.7 VS .70.8±125.8; P=0.63).The number of patients who needed analgesic agents was similar in both groups (P= 0.76). Nausea (P= &lt;0.05) and vomiting (P=0.01) rates were higher in the neostigmine group.Conclusion: Midazolam (50 µg/kg) compared to neostigmine (2 µg/kg) provided higher sedation along with lower incidence of postoperative nausea and vomiting.

Oral Midazolam Vs Promethazine as Pre Sedation Medication in Pediatric Dentistry

Objectives Pre- and post-sedation effect of oral Midazolam to promethazine in2-6 yrs old fearful children for dental treatmentMethods This randomized clinical trial was carried out on a group of 26 children aged 2-6 years referred to the dental school due to their fear and multiple dental needs. Patients were selected from ASA I or II classification and scored 1 in Frankl Behavior scale. Each patient was scheduled for two subsequent visits to receive one of the two pre medications before IV sedation. Each patient served as self-control and randomly assigned to either group A: receiving Midazolam oral as premed in 1st visit or group B: receiving Promethazine oral as the premed in 1st visit. Six hour NPO was instructed prior to sedation visit. Monitoring vital signs were conducted at every 15 minutes starting with base line before any drug administration. Sedation score was recorded using Houpt Sedation scale. Post sedation problems were recorded by operator. Data were analyzed using Student t test and Kruskal Wallis.Results No significant difference was noted between the patient perceptions at the two different visits. Children did not show a significant difference on symptoms such as Crying, Movement, Sleep and overall behavior in two visits at the first 15 minutes of sedative injection. Post-operative complications were having no significant difference. Lower sickness and vomiting were reported following promethazine intake.Conclusion Promethazine seems to be as effective and as acceptable premedication as Midazolam in pediatric dentistry

Mantle Cell Hyperplasia of Peripheral Lymph Nodes as Initial Manifestation of Sickle Cell Disease

Sickle cell disease (SCD) is a well known hemoglobinopathy with usual manifestations including anemia, hyperbilirubinemia, and vasoocclusive complications. Despite presence of mild splenomegaly in early phase of the disease, lymphadenopathy is not an often finding of SCD. We introduce an undiagnosed case of SCD who presented in third decade of his life with multiple cervical lymphadenopathies and mild splenomegaly persistent for about five years. Histopathologic examination of the resected lymph nodes showed expansion of the mantle cell layers of secondary follicles as well as several monomorphic mantle cell nodules. To rule out possibility of a malignant process involving lymph nodes, an immunohistochemical panel was ordered which was in favor of benign mantle cell hyperplasia. Immunoglobulin gene rearrangement study showed no clonal bands and confirmed benign nature of the process. Respecting mild abnormalities on Complete Blood Count, peripheral blood smear was reviewed revealing some typical sickle red blood cells as well as rare nucleated red blood cells. Solubility test for hemoglobin (HB) S was positive. Hemoglobin electrophoresis confirmed diagnosis of homozygous HbS disease

Mantle Cell Hyperplasia of Peripheral Lymph Nodes as Initial Manifestation of Sickle Cell Disease

Sickle cell disease (SCD) is a well known hemoglobinopathy with usual manifestations including anemia, hyperbilirubinemia, and vasoocclusive complications. Despite presence of mild splenomegaly in early phase of the disease, lymphadenopathy is not an often finding of SCD. We introduce an undiagnosed case of SCD who presented in third decade of his life with multiple cervical lymphadenopathies and mild splenomegaly persistent for about five years. Histopathologic examination of the resected lymph nodes showed expansion of the mantle cell layers of secondary follicles as well as several monomorphic mantle cell nodules. To rule out possibility of a malignant process involving lymph nodes, an immunohistochemical panel was ordered which was in favor of benign mantle cell hyperplasia. Immunoglobulin gene rearrangement study showed no clonal bands and confirmed benign nature of the process. Respecting mild abnormalities on Complete Blood Count, peripheral blood smear was reviewed revealing some typical sickle red blood cells as well as rare nucleated red blood cells. Solubility test for hemoglobin (HB) S was positive. Hemoglobin electrophoresis confirmed diagnosis of homozygous HbS disease

COVID-19 in pediatric patients: A case series

The COVID-19 pandemic outbreak has affected the global health system with an urgent need for more sophisticated studies. One of the prominent aspects of COVID-19 is the picture of the disease in pediatric population. Our case series study includes 4 Babyboy patients in a referral children's hospital with different clinical outcomes

The anti-leech effect of ethanolic etract ofachillea millefolium l. Compared to levamisole and niclosamide on limnatis nilotica

This experimental trial was designed to evaluate the anti-Limnatis nilotica effect of Achillea millefolium L. ethanolic extract as well as levimisole and niclosamide. In an experimental study the extract of Achillea millefolium L. aerial parts was prepared and then the severity effect of the treatments was recorded and compared with placebo group on L. nilotica as anti-leech assay. The average time of paralysis and death of L. nilotica for Levamisole, niclosamide and Achillea millefolium L. plant were 12.66±5.19 min, 19.22±3.42 min and 90±17 min, respectively. Distilled water was determined as the inert for control group. In this study, it was determined that Achillea millefolium L. plant with an intensity of 3+ have a good anti-leech effect and can be shown to be effective in cases of leech bitings. © 2014 Vasile Goldis University Press

Emerging Role of Non-Coding RNAs in Senescence

Senescence is defined as a gradual weakening of functional features of a living organism. Cellular senescence is a process that is principally aimed to remove undesirable cells by prompting tissue remodeling. This process is also regarded as a defense mechanism induced by cellular damage. In the course of oncogenesis, senescence can limit tumor progression. However, senescence participates in the pathoetiology of several disorders such as fibrotic disorders, vascular disorders, diabetes, renal disorders and sarcopenia. Recent studies have revealed contribution of different classes of non-coding RNAs in the cellular senescence. Long non-coding RNAs, microRNAs and circular RNAs are three classes of these transcripts whose contributions in this process have been more investigated. In the current review, we summarize the available literature on the impact of these transcripts in the cellular senescence