Dexmedetomidine versus Fentanyl in Children Undergoing Central Venous Catheter Placement at the Pediatric Intensive Care Unit: A Randomized Double-Blind Clinical Trial

Background: The amount of sedation required for children in the pediatric intensive care unit (PICU) is a usually challenging issue. Fentanyl is a commonly used sedative in PICU, but respiratory depression limits its use. Dexmedetomidine (DEX) is an effective sedative and anesthetic agent with negligible respiratory depression and hemodynamic stability.This study was aimed to assess the effects of using DEX as a sedative in comparison to fentanyl. Methods: We conducted a randomized double-blind clinical trial on children aging 1 month to 18 years who were required central venous catheter at PICU. The patients were randomized into the DEX and fentanyl (loading dose 1 mcg/kg and 1 mcg/kg/h for continuous infusion) groups. The primary outcome was defined as the time to achieve Ramsay Sedation Scale (RSS) ≥3, along with the safety outcome. Results: A total of 55 patients were recruited for the analysis between July 7 and December 30, 2020. The two groups were comparable at baseline. There was no statistical difference in the number of patients (63% in DEX and 50% in fentanyl group p=0.39) and the time of reaching RSS≥3 (10 min for DEX and 15 min for fentanyl group p=0.098). Furthermore, the catheterization time between the two groups was not different when the agents were administered individually or with propofol (15 min for DEX and 17.5 min for fentanyl, p=0.225, and 22.5 for DEX and 30 min for fentanyl group, p=0.075 respectively); neither was the safety profile significantly different in the two groups. Conclusions: This study found that DEX as a primary sedative is non-inferior to fentanyl, and it could facilitate sedation alone or in combination with propofol

Bioinformatical Prediction of G-quadruplex Aptamer for Detection of a Ligand in Practice

Considering the introduction of aptamers as a new generation of analyte identifiers, this class of materials can be used in diagnostic systems because aptamers are easier to produce, more sensitive, higher accuracy, less sensitive to environmental factors, easier to handle and can be used. A special type of aptamer that has sequence rich in guanine base can create a special nanostructure called G-quadraplex. The creation of this structure gives the aptamer an enzyme property so that it can act like an enzyme in the vicinity of it, oxidize a chromogenic substrate and produce a colored signal. The main way to produce aptamers is a laboratory technique called SELEX (Systematic evolution of ligands by exponential enrichment), in which a mixture of different oligo libraries in the vicinity of the target analyte creates aptamers in several consecutive cycles. The aim of this study was the introduction a novel approach for obtaining DNA aptamers for detection a ligand such as aflatoxin M1 in bioinformatically manner in replacing to SELEX for obtaining the specific oligoaptamers against aflatoxin M1. For this purpose, the structure of the selected oligoaptamers were predicted using some molecular simulators and bioinformatically techniques. The results of these molecular simulations suggested G-quadruplex aptamers with suitable affinity for binding to aflatoxin M1 in colorimetric assays

The relationship between the religious beliefs and the feeling of loneliness in elderly

The objective of this research is to study the relationship between the religious beliefs and the feeling of loneliness in elderly. In this descriptive correlation study, the statistical society included 100 individuals of the society of retired people in the Medical University of Gilan province in Iran. The sample was taken by the easy random method. The method of collecting data was the questionnaire contained 3 parts: 1) personal characteristics and social characteristics. 2) Allport's internal and external religious beliefs scale and 3) the Standard loneliness feeling of You care. Data was analyzed by means of the description and presumption statistical methods and use of the SPSS software. The findings showed that there is a meaningful correlation between the external religious beliefs and the marital status, the amount of income, socialization with family members and relatives, social activities and also between the internal religious beliefs and the attending in the religious gatherings, the emotional support of the family, friends, and the others and the general satisfaction of the mentioned supports with P<0.05 and finally with the use of the nonparametric testes, a meaningful relationship has been found between the religious beliefs and the feeling of loneliness with P<0.001. Thus this study shows that the religious believes as an important source of support in aged people, can help them to be healthier physically and psychologically and it is essential to consider it for the mental health educational plans. © Indian Society for Education and Environment (iSee)

"Familial" versus "Sporadic" intellectual disability: contribution of common microdeletion and microduplication syndromes

<p>Abstract</p> <p>Background</p> <p>Interstitial Microdeletion and Microduplication syndromes have been proposed as a significant cause of sporadic intellectual disability (ID) but the role of such aberrations in familial ID has not yet been investigated. As the balanced chromosomal abnormalities commonly lead to the recurrent ID or multiple congenital anomalies, this study was designed to evaluate whether it was justified to investigate such aberrations in familial ID patients. Three hundred and twenty eight patients from 101 unrelated Iranian families with more than two ID patients in the first-degree relatives, have been investigated. Assessment of a panel of 21 common Microdeletion and Microduplication syndromes (CMMS) was carried out using Multiplex Ligation-Dependent Probe Amplification (MLPA) technique.</p> <p>Results</p> <p>Among the families studied, 27.7% had 4-12, 35.6% had 3 and 36.6% had 2 affected individuals in the first-degree relatives. An autosomal dominant inheritance of Williams-Beuren syndrome (WBS) was detected in a family with no clinical suspicion of WBS. The prevalence of CMMS was therefore,0.99%.</p> <p>Conclusion</p> <p>This is the first investigation of a panel of CMMS in a large sample set of "familial ID patients". The findings of this study showed the low prevalence of CMMSs in "familial ID" patients in spite of the significant contribution of such aberrations in "sporadic ID" which has a very useful practical impact by avoiding unnecessary diagnostic tests in "familial ID" patients.</p

Efficacy of Isoflurane-Remifentanil versus Propofol-Remifentanil on Controlled Hypotension and Surgeon Satisfaction in Rhinoplasty: A Single-Blind Clinical Trial Study

Background: Rhinoplasty is a complex but popular surgery in Iran. The main complications of the surgery are post-operative bleeding and nasal septal hematoma due to poor intra-operative controlled hypertension. This study aimed to compare the efficacy of isoflurane-remifentanil (I-R) versus propofol-remifentanil (P-R) to induce controlled hypotension and to assess surgeon satisfaction with each of these combinations during rhinoplasty. Methods: In 2020-2021, a single-blind clinical study was conducted on 98 patients aged 18-50 years undergoing rhinoplasty at Mother and Child Hospital (Shiraz, Iran). Patients were randomly divided into P-R (n=48) and I-R (n=50) groups. Changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) were assessed during surgery and in the recovery room. A questionnaire was used to evaluate the level of surgeon satisfaction. Data were analyzed using independent samples t test, Chi-square test, and repeated measures ANOVA with SPSS software. P<0.05 was considered statistically significant.Results: Five minutes after anesthesia induction, the P-R combination had a greater effect on reducing SBP (P=0.010), DBP (P=0.007), MAP (P=0.003), and HR (P=0.026) than I-R. However, from the 40th minute to the end of surgery and after 30 minutes of recovery, the I-R combination had a slightly better effect on blood pressure reduction than P-R. There was no difference in surgeon satisfaction with either of the two drug combinations.Conclusion: Both P-R and I-R combinations are recommended to induce hypotension during rhinoplasty. However, I-R is more effective than P-R in inducing the desired controlled hypotension

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Extended-Interval Dosing of Aminoglycosides in Pediatrics: A Narrative Review

Aminoglycosides (AGs) are frequently used in pediatric settings, especially for empiric treatment of early-onset neonatal sepsis. Although AGs are used for several decades, the optimum method of administration and their dosing schemes needs more clarification. The risks of ototoxicity and nephrotoxicity, two main toxicities associated with AGs, have been contributed to the peak and trough plasma levels, respectively. One approach to decrease these potential toxicities of AGs is to administer higher doses with a prolonged interval, named extended-interval dosing (EID). Post-antibiotic effect (PAE) and concentration-dependent killing of AGs provide rational basis for the efficacy of EID. PAE refers to the extended bactericidal activity of AGs against many Gram-negative organisms after the drug was removed by metabolism. One concern is that the higher initial peak concentration with EID may be accompanied with more toxicities, especially ototoxicity. It was demonstrated that due to saturation of binding site of AGs in renal and cochlear tissues, transiently higher concentration of AGs does not cause additional nephrotoxicity or ototoxicity. Experience and clinical evidence regarding EID in pediatrics is suboptimal. In this review, we presented the rational and studies focusing on EID in pediatric setting. The overall finding of trials is that in pediatric setting, EID is a safe and effective dosing method. The risk of serum drug concentration outside the therapeutic range is lower in neonates treated with EID, leading to less need of therapeutic drug monitoring (TDM) with EID. Moreover, there are evidences supporting lower chance of bacterial resistance with EID compared with traditional dosing approach

Report of thirty one admissions due to adverse drug reactions inBo-Ali Sina hospital, Sari, Iran

, (Received 16 May, 2009 ; Accepted 8 July, 2009)AbstractBackground and purpose: Adverse drug reactions (ADRs) are one of the leading causes of morbidity and mortality, worldwide. Mortality rate due to ADRs are ahead of pulmonary disease, AIDS, pneumonia and automobile accidents. This study evaluated the admission rates in a University teaching hospital related to ADRs.Materials and methods: During this retrospective study between 2001 and 2007, all patients admitted due to adverse drug reaction in Sari Bo-Ali Sina Hospital were evaluated.Results: In these years, 31 patients out of 71,680 were admitted, due to ADRs. Most common ADRs were skin reaction (74%) and fever (22%). Phenobarbital and penicillin were the most common drugs causing ADRs.Conclusion: Only 0.04% of hospital admissions were drug related, while reported admission due to ADRs in other countries were 2.4 to 6.2%. It appears that less drug-depended hospital admissions in Iran rational drug administration, but are due to lack of enough detection, records and reporting procedures.J Mazand Univ Med Sci 2009; 19(71): 67-70 (Persian)