FEV1 over time in patients with connective tissue disease-related bronchiolitis

SummaryBackgroundFibrosis or inflammation of the bronchioles is a well-known manifestation of connective tissue disease (CTD). However, the natural history of CTD-related bronchiolitis is largely unknown.MethodsWe analyzed consecutive patients evaluated at National Jewish Health (Denver, CO) from 1998 to 2008 with CTD and surgical lung biopsy-confirmed bronchiolitis. Linear mixed effects models were used to estimate the longitudinal postbronchodilator FEV1 %predicted (%pred) course and differences between subjects with or without constrictive bronchiolitis (CB).ResultsOf 28 subjects with a mean age of 53 ± 9 years, fourteen (50%) had CB. The most common CTD diagnosis was rheumatoid arthritis (n = 14; 50%). There were no significant differences in demographics, smoking status, underlying CTD diagnoses, 6-min walk distance, dyspnea score or drug therapy between subjects with CB and those with cellular bronchiolitis. Three subjects with CB (11%) and four with cellular bronchiolitis (14%) died. Compared with subjects with CB, those with cellular bronchiolitis had higher mean FEV1 %pred at all times. There were no significant differences in FEV1 %pred slope within- or between-groups (CB vs. cellular bronchiolitis) preceding surgical lung biopsy or afterward.ConclusionSubjects with CTD-related CB had lower FEV1 %pred values than those with CTD-related cellular bronchiolitis at all time points, but FEV1 %pred remained stable over time in both groups regardless of therapy received

A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering

Introduction: Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods: This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1 mg.kg−1, Group C getting clonidine 1 mcg.kg−1 and Group D patients receiving dexmedetomidine 0.5 mcg.kg−1. The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results: Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion: Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable. Resumo: Introdução: O tremor, problema comum no período intraoperatório sob raquianestesia, aumenta consideravelmente o consumo de oxigênio, além de ser desconfortável e angustiante para o paciente, o anestesiologista e o cirurgião. O presente estudo foi concebido para explorar a eficácia de tramadol, clonidina e dexmedetomidina no tratamento de tremores pós-raquianestesia e observar seus efeitos adversos. Métodos: Este estudo prospectivo, randômico, controlado e duplo-cego foi realizado com 90 pacientes que desenvolveram tremores sob raquianestesia. Os pacientes foram randomicamente alocados em três grupos para receber 1 mg.kg−1 de tramadol (Grupo T), 1 mcg.kg−1 de clonidina (Grupo C) e 0,5 mcg.kg−1 de dexmedetomidina (Grupo D). O tempo necessário para controlar os tremores, a taxa de recorrência, as variáveis hemodinâmicas, os níveis de sedação e os efeitos adversos foram registrados. Resultados: Dexmedetomidina foi mais rápida para controlar os tremores, com tempo de 5,7 ± 0,79 minutos (min); o tempo de tramadol foi de 6,76 ± 0,93 min; clonidina foi mais lenta, com tempo de 9,43 ± 0,93 min. A taxa de recorrência foi muito menor no grupo dexmedetomidina (3,3%) que nos grupos clonidina (10%) e tramadol (23,3%). A sedação obtida com dexmedetomidina foi melhor que a obtida com clonidina e tramadol. O grupo tramadol teve mais casos de vômito (quatro); o grupo dexmedetomidina teve seis casos de hipotensão e dois casos de bradicardia. Dois pacientes do grupo clonidina apresentaram bradicardia e hipotensão. Conclusão: Dexmedetomidina foi melhor que tramadol e clonidina para o controlo de tremores devido ao seu início de ação mais rápido e taxa de recorrência mais baixa. Embora complicações tenham sido observadas no grupo dexmedetomidina, elas foram tratáveis. Keywords: Clonidine, Dexmedetomidine, Hypothermia, Shivering, Spinal anesthesia, Tramadol, Palavras-chave: Clonidina, Dexmedetomidina, Hipotermia, Tremor, Raquianestesia, Tramado

A prospective, randomized, double-blinded control study on comparison of tramadol, clonidine and dexmedetomidine for post spinal anesthesia shivering

Abstract Introduction Shivering, a common intraoperative problem under spinal anesthesia increases the oxygen consumption considerably and is uncomfortable and distressing to the patient, anesthesiologist as well as surgeon. The present study was designed to explore the effectiveness of tramadol, clonidine and dexmedetomidine in the treatment of post spinal anesthesia shivering and to look for their adverse effects. Methods This prospective, randomized, double blinded control study was done on 90 patients who developed shivering under spinal anesthesia. They were randomly allocated into three groups with Group T receiving tramadol 1 mg.kg-1, Group C getting clonidine 1 mcg.kg-1 and Group D patients receiving dexmedetomidine 0.5 mcg.kg-1. The time taken to control shivering, recurrence rate, hemodynamic variables, sedation score and adverse effects were observed. Results Dexmedetomidine was faster in the control of shivering in 5.7 ± 0.79 minutes (min) whereas tramadol took 6.76 ± 0.93 min and clonidine was slower with 9.43 ± 0.93 min. The recurrence rate was much lower in the dexmedetomidine group with 3.3% than for clonidine (10%) and tramadol (23.3%) group. The sedation achieved with dexmedetomidine was better than clonidine and tramadol. The tramadol group had more cases of vomiting (four) and dexmedetomidine group had six cases of hypotension and two cases of bradycardia. Two of the clonidine patients encountered bradycardia and hypotension. Conclusion Dexmedetomidine is better than tramadol and clonidine in the control of shivering because of its faster onset and less recurrence rate. Though complications are encountered in the dexmedetomidine group, they are treatable

A clinical study of cutaneous lesions in neonates at a tertiary health care center in Chennai

Background: Neonatal dermatoses constitute an important category of cutaneous disorders. They range from physiological transient conditions at one end to serious pathological entities at the other. Any of these could be a source of immense anxiety to the parents, and therefore the significance of their adequate awareness amongst dermatologists. Aim and Objective: To study the clinical pattern of various dermatoses in neonates at a tertiary health care center in Chennai. Materials and Methods: This was a descriptive, cross-sectional, and observational study conducted at our institute which included a detailed dermatologic examination of each neonate followed by recording each finding and their statistical analysis. Results: In the 220 neonates analyzed, 97 were females (44.1%) and 123 males (55.9%), with 126 being term babies (57.3%), 86 preterm (39.1%), and 8 postterm (3.6%). Physiological skin changes (52.7%) were the most common cutaneous change identified, followed by transient non-infective dermatoses (20%), developmental defects (7.3%), birth marks (7.3%), eczema (6.8%) and infections (5.9%). Conclusion: Studying neonatal dermatoses holds significance to all dermatologists so that they are able to differentiate physiological and pathological conditions, thereby relieving unnecessary therapy for neonates in circumstances not requiring any and also facilitating to allay undue anxiety among parents

Ni(II) complex with bishydrazone ligand: synthesis, characterization, DNA binding studies and pro-apoptotic and pro-differentiation induction in human cancerous cell lines

A new Ni(II) complex, [Ni(L)(H2O)] (1), with diethyl 3,3'-(2,2'-(1,1'-(pyridine-2,6-diyl) bis(ethan-1-yl-1-ylidene)) bis(hydrazin-1-yl-2-ylidene)) bis(3-oxopropanoate) ligand (H2L) was synthesized as a potential chemotherapeutic agent. Polidentate ligand was coordinated to Ni(II) NNN-tridentately, in dianionic form, while monodentate water coordination completed square-planar geometry around metal. Structure in the solution was determined by NMR spectroscopy and the same coordination mode was observed in the solid state using IR spectroscopy and further verified by DFT calculations and electrochemical studies. Thermal stability of 1 was determined in both air and nitrogen atmosphere. Anticancer activity of 1 was investigated on acute monocytic leukemia (THP-1) and pancreatic adenocarcinoma (AsPC-1) cell lines. On THP-1 cells 1 induced powerful apoptotic response (ED50 = 10 +/- 3 mu M), which was revealed to be only partially caspase-dependent, with activation of caspase-8 as the dominant course. This suggested that experimentally validated covalent binding of 1 to DNA is not the only mechanism responsible for programmed cell death. This was supported with experiments on AsPC-1 cells. Although treatment of those cells with 1 resulted in poor apoptotic response, cell cycle changes showed concentration-dependent shifts indicating a dual mechanism of activity. This study also reviews the results of preliminary biological screening, which demonstrates that 1 displays a unique pattern of anticancer activity with at least two mechanisms involved