Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy

Background: The aim of this study was to compare the effect of propofol and ketofol (ketamine-propofol mixture) on EA in children undergoing tonsillectomy.Method: In this randomized clinical trial, 87 ASA class I and II patients, aged 3-12 years, who underwent tonsillectomy, were divided into two groups to receive  either propofol 100 µg/kg/min (group p, n=44) or ketofol : ketamine 25 µg/kg/min + propofol 75 µg/kg/min (group k, n= 43). Incidence and severity of EA was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scales on arrival at the recovery room, and 10 and 30 min after that time.   Results: There was no statistically significant difference in demographic data between the two groups. In the ketofol group, the need for agitation treatment and also mean recovery duration were lower than in the propofol group (30 and 41%, and 29.9 and 32.7 min), without statistically significant difference (P value=0.143 and P value=0.187). Laryngospasm or bronchospasm occurred in 2 patients in each group and bleeding was observed in only one individual in the ketofol group.Conclusion: Infusion of ketofol in children undergoing tonsillectomy provides shorter recovery time and lower incidence of EA despite the non significant difference with propofol.Keywords:  Emergence agitation, ketofol, propofol

Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy

Background: The aim of this study was to compare the effect of propofol and ketofol (ketamine-propofol mixture) on EA in children undergoing tonsillectomy. Method: In this randomized clinical trial, 87 ASA class I and II patients, aged 3-12 years, who underwent tonsillectomy, were divided into two groups to receive either propofol 100 \ub5g/kg/min (group p, n=44) or ketofol : ketamine 25 \ub5g/kg/min + propofol 75 \ub5g/kg/min (group k, n= 43). Incidence and severity of EA was evaluated using the Pediatric Anesthesia Emergence Delirium (PAED) scales on arrival at the recovery room, and 10 and 30 min after that time. Results: There was no statistically significant difference in demographic data between the two groups. In the ketofol group, the need for agitation treatment and also mean recovery duration were lower than in the propofol group (30 and 41%, and 29.9 and 32.7 min), without statistically significant difference (P value=0.143 and P value=0.187). Laryngospasm or bronchospasm occurred in 2 patients in each group and bleeding was observed in only one individual in the ketofol group. Conclusion: Infusion of ketofol in children undergoing tonsillectomy provides shorter recovery time and lower incidence of EA despite the non significant difference with propofol. DOI: https://dx.doi.org/10.4314/ahs.v19i1.50 Cite as: Jalili S, Esmaeeili A, Kamali K, V R. Comparison of effects of propofol and ketofol (Ketamine-Propofol mixture) on emergence agitation in children undergoing tonsillectomy. Afri Health Sci. 2019;19(1). 1736-1744. https://dx.doi. org/10.4314/ ahs. v19i1.5

The C-565T Polymorphism (rs2422493) of the ATP-binding Cassette Transporter A1 Gene Contributes to the Development and Severity of Coronary Artery Disease in an Iranian Population

Objectives: ATP-binding cassette transporter A1 (ABCA1) plays a pivotal role in reverse cholesterol transport from peripheral tissues back to the liver. Abnormalities in ABCA1 function may lead to dyslipidemia and coronary artery disease (CAD). We investigated the role of C-565T (rs2422493) promoter polymorphism of ABCA1 gene in the development and severity of CAD in an Iranian subpopulation. Methods: Our study population consisted of 110 angiographically-confirmed CAD patients and 110 matched controls. The severity of CAD was expressed based on the number of stenotic vessels. Genotyping of C-565T promoter polymorphism was performed using the polymerase chain reaction followed by restriction fragments length polymorphism analysis methods. Lipid profile was determined by routine colorimetric methods. Results: The distribution of ABCA1 C-565T genotypes (p = 0.035) and alleles (p = 0.017) was significantly different between the CAD and control groups. In univariate analysis (with genotype CC as reference), the TT genotype was significantly associated with an increased risk of CAD (odds ratio = 3.83; 95% confidence interval: 1.29–11.30, p = 0.014), but the CT genotype was not (p = 0.321). A multiple binary logistic regression analysis revealed that smoking, hypertension, triglyceride, cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and ABCA1 C-565T dominant genotype were significant and independent risk factors for CAD development (p 0.050). Conclusions: Our study indicated that ABCA1 C-565T polymorphism is a significant risk factor for development and severity of CAD in our population

The Association of Serum Vitamin D Levels and Short Term and 6-month Outcomes among Patients with Acute Coronary Syndrome

Introduction: vitamin D affects the function of most of the cells in the body, including myocytes and endothelial cells, and also affects platelet function. This study aims to evaluate the relation between vitamin D deficiency and in-hospital and 6-month outcomes of patients with the acute coronary syndrome.Methods: This was a prospective cohort study of patients admitted to Mousavi hospital with the diagnosis of acute coronary syndrome. A venous blood sample obtained from patients at the time of admission and 25-hydroxyvitamin D, lipid profile, and hs-troponin-I levels were measured. After coronary angiography, the severity of the coronary artery stenosis was calculated by the syntax score. Patients also evaluated in-hospital outcomes and even followed up for 6-month results.Results: Totally, 204 patients were included in the study. The mean ± SD of age was 60 ± 11.6-year-old. The overall vitamin D deficiency was 80.9%. There was no association between vitamin D deficiency and in-hospital and 6-month mortality in patients with acute coronary syndrome (P = 0.824). There was a direct and statistically significant association between vitamin D levels and HDL cholesterol (P = 0.011). Twenty-eight percent of patients with negative hs-troponin-I and 14% with positive hs-troponin-I had normal vitamin D levels, which was statistically significant (P = 0.045).Conclusion: This study does not demonstrate an association between vitamin D levels and in-hospital and 6-month outcomes in patients with the acute coronary syndrome

The study of association between reduced folate carrier 1 (RFC1) polymorphism and non-syndromic cleft lip/palate in Iranian population

Introduction: Cleft lip/palate is one of the most common congenital defects and is supposed to have multifactorial etiology, including a complex interaction between genetics and environment. Reduced folate carrier 1 (RFC1) gene takes part in folate transportation within the cells. In this study, the association of A80G polymorphism in the RFC1 gene with the non-syndromic cleft lip/palate (nsCL/P) was investigated in Iranian infants for the first time. Methods: In this case-control survey, 122 Iranian infants with nsCL/P and 164 healthy infants were investigated for RFC1 polymorphism by PCR and RFLP methods. The results were statistically compared with control group, odds ratios with 95% CI were estimated by univariate and multivariate logistic regression model and a P <0.05 was considered statistically significant. Results: The RFC1 G allele was significantly higher (P=0.001; OR=7, 95% CI: 4.7-10.2) in the cases (60.3%) compared with the controls (17.9%). Not only the RFC1 AG genotype was significantly higher (P<0.001; OR=44, 95% CI: 14.6-133) in cases (67.8%) than the controls (27.4%), but also GG genotype (P<0.001; OR=85, 95% CI: 20.5-352) was much higher in cases (26.4%) than the controls (4.3%). Conclusion: Our study indicated that the RFC1 (A80G) polymorphism was associated with the nsCL/P in Iranian population. Moreover, 80GG homozygosity was significant in the cases. The presence of G allele can be considered as a risk factor for the nsCL/P. Infants with the GG and AG genotypes were more prone to cleft lip/palate as compared to the AA ones. This finding emphasizes the role of RFC1 gene and the intracellular levels of folate

The prevalence and impact of tension-type headache in school-aged children in Iran

BackgroundTension-Type Headache (TTH) is regarded as the third most prevalent disorder worldwide, prompting children to seek medical attention. Our objective is to investigate the prevalence of TTH among students aged 6 to 18 years in various geographical regions of Iran, while also assessing the impact of headaches on their quality of life.MethodsEmploying a cross-sectional survey, we have carefully distributed self-completed structured questionnaires to students in 121 meticulously selected schools throughout the country, ensuring the representation of its diverse population.ResultsAmong the 2,958 potential participants, we have included a total of 2031 individuals in our study. This comprises 57.3% children and 42.7% adolescents, with 50.02% being males and 49.97% females. Specifically, we have examined 950 subjects with TTH and 1,081 individuals without any form of headache. TTH was diagnosed in 32.1% of the participants. Notably, we have observed a significant difference in the average age between the TTH subjects and those without headaches. Participants without headaches were more likely to be enrolled in primary schools, while those diagnosed with TTH predominantly attended high schools. We found no significant relationship between urban–rural areas or different geographic regions and the prevalence of TTH or its subtypes. Phonophobia was commonly associated with TTHs. Lastly, the mean quality-of-life score was highest for individuals without headaches, followed by those with low frequency episodic TTH, high frequency episodic TTH, and chronic TTHs. There was also a significant relation between headache severity and quality of life scores.ConclusionThe significant prevalence of TTH in children and adolescents and its adverse impact on the daily activities of individuals underscore the utmost importance of accurate diagnosis and efficient management

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method: A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services

Task Performance induced Work Load in Nursing

Background & objective: High workload may lead to increase human errors, compromise quality and safety of care, and reduce the nurses’ quality of working life. The aim of this study is to determine the task-induced workload in nursing. Methods: This is a descriptive analytical study. All of 214 nurses of one of the educational hospital took part in. After obtaining informed consent from participants, data were collected based on NASA-TLX questionnaire and the desired level assumed less than 50%. Analysis of data was performed by descriptive statistics and Anova in SPSS software (version 11. 0) at significant level of 0.05. Results: The results showed that perceived mental pressure for nurses is more than other NASA-TLX subscales (P< .001). Also, the mean perceived workload was more than 50%. However, mean workload score of NASA-TLX showed significant correlation with age (P< .001), work experience (P< .001), shift work (P< .02), and department (P< .001). Conclusion: The results show that effective programs will be required to reduce the work load, and to enhance nurses' performanc