Morphine in Plasma and Cerebrospinal Fluid of Patients Addicted to Opiates Undergoing Surgery: High-performance Liquid Chromatography Method

Background: The prevalence of opium addiction among Iranians is considerable. Since endogenous opioid systems may be altered as a consequence of addiction, it is very important to determine the plasma and cerebrospinal fluid (CSF) levels of morphine in Iranian patients addicted to opiates who will undergo surgery.Methods: We obtained CSF and plasma samples from 50 volunteers with an established opioid addiction pattern. Samples were analyzed using high-performance liquid chromatography (HPLC). Additionally, frequency of nausea and vomiting, baseline heart rate (BHR), and systolic blood pressure (SBP) were recorded within the surgery and postoperatively during a 10-min interval.Findings: 84% of participants were men with a median age of 39.08 years. Mean score of body mass index (BMI) was 23.30 and most of the participants (46%) used opium in its traditional inhaled form. A higher concentration of morphine in blood was found in comparison with CSF (P < 0.001) in relation to the way of use. However, no statistically significant differences were found in relation to the type of addictive substance. No other association was found between the levels of morphine and the clinical characteristics of the patients. Moreover, results revealed no difference between hemodynamic-related data with blood and CSF level in opium-dependent patients.Conclusion: Quantification of plasma and CSF morphine, both immediately before initiation of surgery and subsequently on recovery room, showed that although clinical efficacy of systemic morphine was poor in addicted patients, it had no effect on patients’ hemodynamic variable and following complications after surgery

Admission Dysnatremia in Citically ill Children

Introduction: Many causes of admission to the pediatric intensive care unit (PICU) may potentially induce hyponatremia. This study was aimed at evaluating the incidence of admission dysnatremia in the PICU and its relationship with the underlying disease and demographic factors.Materials and Methods: This observational prospective study was conducted in a 12-bed medical PICU in a tertiary governmental teaching hospital for six months. The study group comprised patients aged 1 month to 18 years. Patients who received intravenous fluid within 24 hours before admission were excluded. Serum sodium was checked on admission and concentrations below 135 and above 145 mEq/L were considered hyponatremia and hypernatremia, respectively.Results: One hundred and ninety-five patients (117 males, 60%) were included in the study. The mean serum sodium level was 137.8 mEq/L ± 5.2. Forty-two patients (20.5%) were hyponatremic and 10 (5.1%) werehypernatremic. The most prevalent diagnosis in hyponatremic patientswas pulmonary diseases followed by renal diseases, central nervoussystem (CNS) diseases, diabetic ketoacidosis (DKA), gastrointestinal (GI)diseases, and cardiovascular and hematologic-oncologic diseases. Fiftypercent of nephrologic patients were hyponatremic. Hyponatremia wasfound in 26.5%, 23.5%, 20%, 16.6%, and 14.2%of the children with lungdiseases, DKA, hematologic-oncologic diseases, cardiovascular diseases,and CNS and GI diseases, respectively. Moreover, 20%, 16.6%, 11.7%,7.1%, and 2.9%of the patients with infectious diseases, cardiovasculardiseases, DKA, CNS diseases, and pulmonary diseases hadhypernatremia, respectively.Conclusions: Hyponatremia is frequent in our PICU. Patients suffering from renal diseases, pulmonary problems, DKA, and hematologic-oncologic diseases have a higher chance of hyponatremia (≥20%).Keywords: Sodium; Hyponatremia; Fluid Therapy; Children; Intensive Care

Novel insights into the treatment of SARS-CoV-2 infection : An overview of current clinical trials

The emergence of the global pandemic caused by the novel SARS-CoV-2 virus has motivated scientists to find a definitive treatment or a vaccine against it in the shortest possible time. Current efforts towards this goal remain fruitless without a full understanding of the behavior of the virus and its adaptor proteins. This review provides an overview of the biological properties, functional mechanisms, and molecular components of SARS-CoV-2, along with investigational therapeutic and preventive approaches for this virus. Since the proteolytic cleavage of the S protein is critical for virus penetration into cells, a set of drugs, such as chloroquine, hydroxychloroquine, camostat mesylate have been tested in clinical trials to suppress this event. In addition to angiotensin-converting enzyme 2, the role of CD147 in the viral entrance has also been proposed. Mepolizumab has shown to be effective in blocking the virus's cellular entrance. Antiviral drugs, such as remdesivir, ritonavir, oseltamivir, darunavir, lopinavir, zanamivir, peramivir, and oseltamivir, have also been tested as treatments for COVID-19. Regarding preventive vaccines, the whole virus, vectors, nucleic acids, and structural subunits have been suggested for vaccine development. Mesenchymal stem cells and natural killer cells could also be used against SARS-CoV-2. All the above-mentioned strategies, as well as the role of nanomedicine for the diagnosis and treatment of SARS-CoV-2 infection, have been discussed in this review. (C) 2020 Elsevier B.V. All rights reserved.Peer reviewe

Evaluation of intra ocular pressure and hemodynamic change following intubation with Maccoy, Macintosh and Video laryngoscope

Background & Objective: The induction of anesthesia, laryngoscopy and endotracheal intubation can be associated with adverse hemodynamic response and increased intraocular pressure. The aim of this study was to evaluate intraocular pressure and hemodynamic changes after laryngoscopy and endotracheal intubation with three methods of laryngoscopy (Macintosh, Maccoy and Video laryngoscope).Materials & Methods: One hundred and eighty patients with American Society of Anesthesiology (ASA) classification of I and II, aged 20-70 year, were enrolled in a randomized clinical trial (RCT). Anesthesia was induced by administration of Propofol 2 mg/kg, Fentanyl 1µg/kg and Cisatracurium 0.1mg/kg. the Hemodynamic information of the patients and intraocular pressures were documented and assessed in three stages (after induction of anesthesia and endotracheal intubation, and 5 minutes after endotracheal intubation using Maccoy, Macintosh and Video laryngoscope).Results: Hemodynamic parameters' of patients increased in these three groups compared with those of pre anesthesia measures, but this increase was not significant. Evaluation of intraocular pressure (IOP) in Video laryngoscope group showed that there is a significant drop in intraocular pressure (IOP) compared with other groups. There weren’t any significant differences of IOP after intubation in Maccoy compared to the Macintosh group. Nevertheless there was not any significant difference in IOP, before and five minutes after intubation in these groups.Conclusion: According to a low degree of augment of IOP in Video laryngoscope group and no changes in the Hemodynamic parameters, it seems that the use of Video laryngoscope in eye surgeries might be more suitable for endotracheal intubation

Evaluation of Mexiletine Effect on Bispectral Index Changes and Hemodynamic Responses to Endotracheal Intubation and During General Anesthesia

  Background &Objective: Plaryngoscopy and tracheal intubation increase not only blood pressure and heart rate but also Bispectral Index (BIS) of the patients. In this study, hemodynamic and BIS changes were surveyed after tracheal intubation and during general anesthesia followed by mexiletine prescription . Materials & Methods: In this study, 50 patients aged between 20 and 60 who were candidates for orthopedic surgery of the upper limbs were surveyed. They were divided in two groups randomly. Two hours before induction of anesthesia,  case and control groups received mexiletine 200 mg as capsule and oral placebo, respectively. Systolic  and diastolic blood pressures ,heart rate, and BIS of both groups were compared before induction and intubation; 1,3 and 10 minutes after intubation; and immediately  , 15, 30, 45, and 60 minutes  after  surgical incision. Results:&nbsp;There was not any significant differences in systolic and diastolic pressures of the two groups.  The heart rate was lower in mexiletine group compared to control group, 30 minutes after surgical incision and immediately after extubation (P<0.05).&nbsp;BIS was significantly more in mexiletine groupcompared to control group (p<0/05). Conclusion: It was revealed that  the hemodynamic changes after laryngoscopy and during general anesthesia were significantly lower in mexiletine group compared to the  control group. It`s suggested that the prescription of this drug leads to the increase of BIS after intubation and during general anesthesia

Design and Evaluation of an Anesthesia Decision Support Mobile Application

Introduction: Anesthesia is one of the processes in which medication error is common. One of the most frequent medication errors in anesthesia is the error in calculating the dose of drugs. Decision support systems are one of the available solutions to reduce these errors. The purpose of this study was to design and evaluate an anesthesia decision support mobile application to assist anesthesiologists to choose the right and timely prescription of drugs. Method: This practical cross-sectional study was conducted in three stages including needs assessment, design, and evaluation. The needs assessment of this mobile app was performed using semi-structured interviews with physicians. After drawing the initial design, the mobile app was developed for the Android operating system, and in the end, it was evaluated based on accuracy and speed of calculation indicators. Results: The output of the interviews was classified into three categories including physicians’ views on the need to develop the app, the expected facilities and capabilities of the app, and the information content of the app. The evaluation results of this app showed that in all groups, except the expert group, the calculation time required by physicians was longer than the one by the mobile app. Moreover, the highest number of correct answers was given by the app user group and then the fourth-year resident group. Conclusion: An anesthesia decision support mobile app for physicians can significantly increase the accuracy and speed of physicians’ medication calculations. So far, no anesthesia mobile app has been developed in Iran according to valid international guidelines. Therefore, the results of this study can be taken into consideration by health service providers

Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p = 5.4, 95% CI = 5.1-5.7) and encopresis (p = 0.13, 95% CI = 0.09-0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p = 11, 95% CI = 9.5-12.7) and Separation Anxiety (p = 10.6, 95% CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders