Vitamin D Insufficiency in Children with Chronic Neurological Diseases: Frequency and Causative Factors

  Objective Vitamin D insufficiency/rickets is a metabolic bone disease that leads to insufficient mineralization of bone. Chronic neurological diseases, including cerebral palsy (CP), convulsive disorders, neural tube defects, myopathy, immobility, lack of sun exposure, inadequate nutrition, and antiepileptic drugs (AEDs) can cause vitamin D insufficiency and osteopenia in children. Materials & Methods In this study, the authors searched the frequency and causative factors of vitamin D insufficiency in children with chronic neurological diseases such as CP, hypoxic-ischemic encephalopathy, mental motor retardation, epilepsy, neurodegenerative and neuromuscular diseases, meningitis-encephalitis sequelae, neural tube defects, paralysis, and paresis. This cross-sectional study included 108 children (forty-five [41.6%] females; sixty-three [58.4%] males), aged between one and 18 years with chronic neurological diseases, and a control group of thirty age-matched healthy children (16 [53.3%] females; 14 [46.7%] males. Results Vitamin D levels were significantly lower, and parathyroid hormone (PTH) levels were significantly higher in the patient group than in the control group (p<0.05). The patient group was divided into four subgroups: (i) Epilepsy (n=41; 38%), (ii) Neural tubedefects (n=14; 13%), (iii) CP (n=21; 19%), and (iv) other diseases (neurodegenerative and neuromuscular diseases, meningitis sequelae, intracranial hemorrhage, psychomotor retardation, hypoxic-ischemic encephalopathy) (n=32; 30%) to identify any differences in the measured levels. In the patient group, eighty-three (76.9%) had vitamin D deficiency, and 17 (15.7%) had vitamin D insufficiency, while in the control group, twenty-one (70%) had vitamin D insufficiency. The use of AEDs had no significant effect on serum Ca, P, ALP, PTH, orvitamin D levels (p>0.05), and serum Ca levels were significantly higher in ambulant patients than in non-ambulant patients (p<0.05). Vitamin D levels were significantly higher in the non-ambulant than in the ambulant patients (p<0.05). No rickets was determined in the control group, while in the patient group, nine (8.3%) had level-1 rickets, six (5.6%) had level-2 rickets, and two (1.9%) had level-3rickets. Conclusion Children with chronic neurological diseases have low serum vitamin D levels, and vitamin D prophylaxis is essential in this grou

Open-source software for automated rodent behavioral analysis

Rodent behavioral analysis is a major specialization in experimental psychology and behavioral neuroscience. Rodents display a wide range of species-specific behaviors, not only in their natural habitats but also under behavioral testing in controlled laboratory conditions. Detecting and categorizing these different kinds of behavior in a consistent way is a challenging task. Observing and analyzing rodent behaviors manually limits the reproducibility and replicability of the analyses due to potentially low inter-rater reliability. The advancement and accessibility of object tracking and pose estimation technologies led to several open-source artificial intelligence (AI) tools that utilize various algorithms for rodent behavioral analysis. These software provide high consistency compared to manual methods, and offer more flexibility than commercial systems by allowing custom-purpose modifications for specific research needs. Open-source software reviewed in this paper offer automated or semi-automated methods for detecting and categorizing rodent behaviors by using hand-coded heuristics, machine learning, or neural networks. The underlying algorithms show key differences in their internal dynamics, interfaces, user-friendliness, and the variety of their outputs. This work reviews the algorithms, capability, functionality, features and software properties of open-source behavioral analysis tools, and discusses how this emergent technology facilitates behavioral quantification in rodent research

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Postoperative analgesia in children: comparison of bupivacaine with a mixture of bupivacaine and alfentanil

WOS: 000171314800009PubMed ID: 11553247

A comparison of midazolam or dexmedetomidine for the prevention of myoclonic movements and injection pain following etomidate injection

WOS: 000209824000473

Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period

PubMedID: 14768925Background and objective: To compare the antiemetic efficacy of ondansetron with two different hypnotic drugs (propofol 15 mg, midazolam 1 and 2 mg) for the treatment of established postoperative nausea and vomiting (PONV). Methods: Four-hundred-and-fifty-three patients scheduled for elective gynaecological or abdominal surgery were enrolled. One-hundred-and-twenty patients (26%) experienced postoperative emesis, and when nausea scores reached 2 or greater on a five-point scale, they were randomized to receive intravenously: propofol 15 mg (1.5 mL) in Group P, midazolam 1 mg in Group M1, midazolam 2 mg in Group M2 and ondansetron 4 mg in Group O. Results: Four patients (13.3%) in Group P, 13 patients (43.3%) in Group M1, five patients (16.6%) in Group M2 and one patient (3.3%) in Group O required a second dose of the study drug. After administration of the study drugs, nausea scores were significantly lower in all groups than before these drugs were given. No patient had a sedation score over 3 (the patients remained awake and/or responded to verbal contact). The sedative effects of midazolam and propofol lasted for a much shorter time than the antiemetic effects of these drugs. Conclusions: Propofol and midazolam used in subhypnotic doses were as effective as ondansetron in treating PONV in patients undergoing abdominal or gynaecological surgery without untoward sedative or cardio-vascular effects

A comparison of midazolam and dexmedetomidine for the prevention of myoclonic movements and pain following etomidate injection

Background: Etomidate may cause injection pain and myoclonus during the anaesthesia induction. Both benzodiazepines and opioids reduce myoclonus, however so far dexmedetomidine has not been studied for the same. We designed a study to investigate the effects of pretreatment with IV midazolam or dexmedetomidine on the incidence and severity of myoclonus and injection pain during induction of anaesthesia with etomidate. Patients & Methods: 152 patients were pre-treated before the etomidate injection, either with saline (Group P, n= 51) or midazolam 0.5 mg/kg (Group M, n=51) or dexmedetomidine 1 microg/kg (Group D, n=50). Results: Both Groups M and D showed a significantly lower incidence of myoclonus compared with Group P. Within 60 s after induction with etomidate, 19 (37%) of 51 patients in the midazolam group, 15 (30%) of 50 patients in the dexmedetomidine group and 46 (90%) of 51 patients in the placebo group developed myoclonic movements. Also, within 60 s after induction with etomidate, 1 (2%) of 51 patients in the midazolam group, 3 (6%) of 50 patients in the dexmedetomidine group and 43(6%) of 51 patients (85%) in the placebo group developed injection pain after the etomidate induction. Conclusion: We conclude that either dexmedetomidine or midazolam administered before etomidate induction reduces myoclonic muscle movements and injection pain during anaesthesia induction without any haemodynamic side effects

Andiferansiye Bağ Doku Hastalıklı Olguda Gluteal Kalsinozis: Cerrahi Rezeksiyonu Yapılmış Dev Lezyon

Calcinosis frequently accompanies rheumatologic diseases and mostly occurs after trauma, due to structural damage, hypovascularity, and tissue hypoxia. Calcinosis may be seen in a localized area or it may be widespread, causing muscle atrophy, joint contractures, and skin ulceration. Herein, we report a patient with localized form of calcinosis that occured without history of trauma and the patient also has a diagnosis of undifferentiated connective tissue disease. Turk J Phys Med Rehab 2011;57 Suppl 2: 358-60.Wo

The comparison of rocuronium and vecuronium induced neuromuscular block during sevofluran and isoflurane anaesthesia [Sevofluran ve isofluran anestezisi sirasinda rokuronyum ve vekuronyumun olusturdugu noromuskuler blok'un karsilastirilmasi]

Eighty adult patients were accepted to study undergoing elective orthopedic, laparascopic or plastic surgery following informed consent and approval by our ethical committee. Anaesthesia induction was obtained with thiopentone (5 mg/kg) and maintained with 2 % sevoflurane or 1 % isoflurane + 66 % N2O in oxygen. Peripheric nerve stimulator was set on following anaesthesia induction. The patients were assigned randomly four groups equally. To group I 2 % sevoflurane + vecuronium, to group II 2 % sevoflurane + rocuronium, to group III 1 % isoflurane + vecuronium, to group IV 1 % isoflurane + rocuronium were applied. All patients were intubated when 95 % neuromuscular block obtained. The onset time (T95), clinical duration(T25), recovery index (T75-25) and spontaneous recovery time (T90) and endotracheal intubation conditions were assessed in four groups of patients. Haemodynamic and demographic data did not show any difference among groups (p>0.05). Intubation condition were statistically significant in group I than group II and in group III than group IV (p<0.05). T95 values were found statistically significant long in group I than group II and in group III than group IV (p<0.001). T25 values did not show any difference among groups (p>0.05). T75-25 values were found longer in group I than group II. In conclusion the onset of action of rocuronium was faster than vecuronium whereas vecuronium induced intubation conditions were better than rocuronium. T75-25 and T90 is similar in all groups and 2 % sevoflurane or 1 % isoflurane did not change rocuronium and vecuronium induced neuromuscular block

Pre-emptive analgesic efficacy of tramadol compared with morphine after major abdominal surgery

PubMedID: 12878619Background. Studies of pre-emptive analgesia in humans have shown conflicting results. This prospective, randomized, double-blind, controlled study was designed to test the hypothesis that a reduction in postoperative morphine consumption can be achieved by tramadol administered after induction of anaesthesia. Methods. Ninety patients were allocated randomly to receive i.v. tramadol (1 mg kg-1) (Group T), morphine (0.1 mg kg-1) (Group M) or saline 2 ml (Group S) after induction of anaesthesia. At peritoneal closure, a standardized (0.1 mg kg-1) morphine loading dose was given to all patients for postoperative pain management. Patients were allowed to use a patient-controlled analgesia (PCA) device giving bolus doses of morphine 0.025 mg kg-1. Discomfort, sedation, pain scores, cumulative morphine consumption, and side-effects were recorded at 1, 2, 6, 12 and 24 h after the start of PCA. Results. There were no significant differences between groups in mean pain, discomfort, and sedation scores at any study period. Cumulative morphine consumption was significantly lower in Group M at 12 and 24 h after starting the PCA than in Group S. In Group T, it was lower only after 24 h (28% less in Group M and 17% less in Group T; P<0.017). There were no significant differences in morphine consumption between Groups T and M. Conclusions. Tramadol (1 mg kg-1), administered after induction of anaesthesia, offered equivalent postoperative pain relief, and similar recovery times and postoperative PCA morphine consumption compared with giving morphine 0.1 mg kg-1. These results also suggest that presurgical exposure to systemic opioid analgesia may not result in clinically significant benefits