Rectal Thiopental versus Intramuscular Ketamine in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial

Introduction: Physicians frequently deal with procedures which require sedation of pediatric patients. Laceration repair is one of them. No study has been performed regarding the comparison between induction of sedation with sodium thiopental and ketamine in laceration repair. Therefore, the present study was aimed to comparison of induced sedation by rectal sodium thiopental and muscular injection of hydrochloride ketamine in pediatric patients need laceration repair. Methods: The presented study is a single-blinded clinical trial performed through 2013 to 2014 in Ayatollah Kashani and Alzahra Hospitals, Isfahan, Iran. Patients from 3 months to 14 years, needed sedation for laceration repair, were entered. Patients were sequentially evaluated and randomly categorized in two groups of hydrochloride ketamine with dose of 2-4 milligram per kilogram and sodium thiopental with dose of 25 milligram per kilogram. Demographic data and vital signs before drug administration and after induction of sedation, Ramsey score, time to onset of action, and sedation recovery time were evaluated. Chi-squared, Mann-Whitney, and Non-parametric analysis of covariance tests were used. P<0.05 was considered as a significant level. Results: In this study 60 pediatric patients were entered. 30 patients with mean age of 42.8±18.82 months were received sodium thiopental and the rest with mean age of 30.08±16.88 months given ketamine. Mann-Whitney test was showed that time to onset of action in sodium thiopental group (28.23±5.18 minutes) was significantly higher than ketamine (7.77±4.13 minutes), (p<0.001). The sedation recovery time in ketamine group (29.83±7.70) was higher than sodium thiopental. Depth of sedation had no significant difference between two groups based on Ramsey score (p=0.87). No significant difference was seen between two groups in the respiratory rate (df=1, 58; F=0.002; P=0.96) and heart rate (df=1, 58; F=0.98; P=0.33). However, arterial oxygen saturation level (df=1, 58; F=6.58; P=0.013) was significantly higher in ketamine group. Conclusion: The findings of the present study show that Although the recovery time from sedation by ketamine is more than sodium thiopental, it’s fast-acting function without effecting on the oxygen saturation level causes that ketamine is considered as the better choice for induction of sedation in pediatric patients need laceration repair. In addition, long-term effect of ketamine provides more time for the physician to do the procedure and this issue decreases the need probability to the repeated-dose. However, effectiveness of both drugs to decrease the agitation was equal, based on the Ramsey score

Oral Chloral Hydrate Compare with Rectal Thiopental in Pediatric Procedural Sedation and Analgesia; a Randomized Clinical Trial

Introduction: The increasing use of diagnostic imaging in pediatric medicine has resulted in growing need for procedural sedation and analgesia (PSA) to minimize motion artifacts during procedures. The drug of choice in pediatric PSA was not introduced till now. The aim of the present study was comparison of oral chloral hydrate (OCH) and rectal sodium thiopental (RST) in pediatric PSA.Methods: In the present randomized clinical trial, 2-6 years old pediatrics who referred for performing brain computed tomography scan was enrolled and were randomly divided in to two groups. OCH (50mg/kg) and RST (25mg/kg) were prescribed and a trained nurse recorded the time from drug prescription to receiving the conscious sedation (onset of action), the total time period which the patient has the Ramsay score≥4 (duration of action), and adverse effect of agents. Mann-Whitney U test and chi-squared test, and Non-parametric analysis of covariance (ANCOVA) were used for comparisons. Results: One hundred and forty children were entered to two groups of OCH and RST, randomly. The patients of two groups had similar age, sex, weight, and baseline vital signs except for diastolic blood pressure (p<0.001). The onset of action in OCH and RST groups were 24.5±6.1and 28.7±5.2 minutes, respectively (p<0.001). Duration of action in OCH and RST groups were 12.9±2.8 minutes and 13.7±2.6 minutes, respectively (p=0.085). Non parametric ANCOVA revealed that only diastolic blood pressure was affected by drug prescription (p=0.001). In 11(15.7%) patients in RST group, diarrhea was observed during 24 hours (p=0.001). Oxygen desaturation was observed only in two patients, both in OCH group. Conclusion: Each of the sedative has advantages and disadvantages that should be considered when selecting one for inducing short-term sedation. It seems that rectal sodium thiopental and oral chloral hydrate are equally effective in pediatric PSA and based on patient’s condition we can administrate one of these agents.

Assessment of Organophosphorus Pesticide Residues in Water and Sediment Collected from the Southern Caspian Sea

Pollution of water resources by uncontrolled pesticide use is a serious health and environmental issue. In this study, concentrations of three organophosphorus pesticides (diazinon, malathion, and azinphos-methyl) in water and sediment samples from five estuaries (Sefidrud, Chalus, Babolrud, Tajan, and Gorganrud) along the Caspian Sea were investigated. Samples were collected from surface water and sediment during summer to autumn, and pesticides were analysed by gas chromatography-mass spectrometry (GC-MS). Results indicated that salinity and turbidity in Gorganrud were higher (salinity: range 2–8%; turbidity: range 1–9%) compared to other stations. Higher diazinon (water: 0.08±0.06, sediment: 0.04±0.01), malathion (water: 0.09±0.06, sediment: 0.05±0.01) and azinphos-methyl (water: 0.1±0.08, sediment: 0.06± 0.02) concentrations were observed in the Tajan river compared to other stations. Mean concentrations of diazinon, malathion and azinphos-methyl pesticides were higher in the summer compared to the autumn. Azinphos-methyl concentrations were higher than sediment quality guidelines (SQGs), which warrants ongoing monitoring. Our research provides insights into the presence of organophosphate pesticides (OPs) in rivers that enter into the Caspian Sea. Further work to better understand the environmental pollution of OPs in the Caspian Sea is ongoing

Integrated Transmission And Distribution Systems Restoration With Distributed Generation Scheduling

The self-healing smart grids enable system operators to quickly and efficiently recover transmission and distribution systems from outages and blackouts. The current restoration procedure solves the transmission and distribution system restoration problems separately without considering their impacts on each other, which may prolong the restoration process. However, with the emerging active distribution networks, distributed generators can contribute into the bottom-up restoration strategy. The interaction between the restoration of two interconnected systems should be taken into account. In this paper, a hybrid model of transmission and distribution systems restoration (HTDSR) is proposed by exchanging data of power and voltage between two separate optimization problems. The effectiveness of the HTDSR algorithm is demonstrated through case studies of the integrated IEEE 13-bus distribution network and IEEE 39-bus transmission grid. Simulation results demonstrate that the integrated restoration strategy with optimal scheduling of distributed generation sources can expedite the restoration process

Malaria in Fars during Qajar Era (1789-1925)

زمینه و هدف: مالاریا یا تب نوبه بیماری که عامل آن تک‌سلولی به نام پلاسمودیوم و توسط پشه آنوفل به انسان منتقل می‌شود. مالاریا یکی از بیماری‌های بومی ایران بود و سالیانه 40-30 درصد مرگ ‌و میرها به این اختصاص داشت. بیماری در خراسان و مازندران و کرمان کانون‌های پراکنده‌ای را به وجود آورده بود، یکی از مناطقی که به آن کمتر پرداخته شده، منطقه ایالت فارس در جنوب ایران است. جغرافیای بیماری مالاریا از شیراز آغاز می‌شد، چنانکه هواي شهر شیراز در تابستان گرم و با عفونت همراه بود که این امر باعث بروز انواع بیماری‌هایی چون مالاریا می‌گردید، به گونه‌اي که مالاریا در این شهر بیداد می‌کرد. در دیگر نقاط فارس که به عنوان مناطقی که بیماری مالاریا شدت داشت، در شمال فارس از نقاطي که خرما در آنجا مي‌رویید، شروع مي‌شد و تا سواحل خلیج فارس ادامه مي‌یافت و در نواحي جنوبي‌تر به‌ ویژه بندر بوشهر شدت آن زیادتر بود. در نواحي لار و لارستان حشرات انتقال‌دهنده بیماری، بسیار وجود داشتند. مواد و روش‌ها: ﺭﻭﺵ به کارگرفته‌شده در ﺍﻳﻦ ﭘﮋﻭﻫﺶ، ﺭﻭﺵ ﻛﺘﺎﺑﺨﺎﻧﻪﺍﻱ ﻭ ﭘﮋﻭﻫﺸﻲ ﺗﺎﺭﻳﺨﻲ (Historical Research) ﻣﻲﺑﺎﺷﺪ ﻭ ﻧﮕﺎﻫﻲ ﺗﺎﺭﻳﺦ‌ﻧﮕﺎﺭﺍﻧﻪ ﻭ ﺷﻴﻮﻩﺍﻱ روایی ﻛﻪ ﺩﺭ ﻋﻠﻮﻡ ﺍﻧﺴﺎﻧﻲ ﻣﺮﺳﻮﻡ ﻣﻲﺑﺎﺷﺪ، ﺑﻪ ﺑﺮﺭﺳﻲ بیماری مالاریا در فارس در دوره قاجار دارد. یافته‌ها: مالاريا از جمله مهم‌ترين بيماري‌هاي شايع در ایالت فارس در دوره قاجار بوده است و تلفات بسياري نيز به بار مي‌آورد. در اين مقاله جنبه‌هاي گوناگون اين بيماري را به کمک منابع تاریخی، روزنامه‌ها و اسناد مورد بررسي قرار می‌گیرد. ملاحظات اخلاقی: کمیته اخلاقی گروه تاریخ، دانشکده ادبیات و علوم انسانی، دکتر علی شریعتی از دانشگاه فردوسی این مطالعه را تأیید کرد. نتیجه‌گیری: در این مقاله با بررسی بیماری مالاریا در مکان جغرافیای ایالت فارس و در دوره قاجار (1925-1789 م.) می‌پردازیم. ابتدا اهمیت آسیب‌شناسی تاریخ بیماری مالاریا در ایران مورد بررسی قرار گرفت و سپس به بررسی نقش شیوع بیمارى مالاریا به عنوان عاملی که سبب تلفات انسانی در منطقه جنوب ایران و ایالت فارس بوده را مورد بررسى و تحلیل قرار دادیم.Background and Aim: Malaria is a disease caused by single-celled microorganisms of Plasmodium group and is transmitted to humans by a female Anopheles mosquito. Malaria was a disease native to Iran and accounted for 30-40% of annual casualties. The disease had spread to Khorasan, Mazandaran, and Kerman in a dispersed manner. Fars region which is located in the southern Iran is an area that is not addressed well enough on this matter. Geographical spread of malaria began from Shiraz, as the weather in Shiraz was hot and infected in the summer, causing a variety of diseases such as malaria that used to be rampant in this city. Other parts of Fars where malaria was most prevalent included a vast area from lands in the northern Fars, where dates grew, to the shores of the Persian Gulf, and this disease was more prevalent in the southern parts, especially in Bandar Bushehr [Bushehr Port]. There were many disease-carrying insects in Lar and Larestan. Materials and Methods: This historical research is carried out as a desk study and studies malaria in Fars during Qajar era with a histographic perspective through a narrative method, which is specific to natural sciences. Findings: Malaria was one of the most common diseases in Fars province during the Qajar period and caused many casualties. In this article, various aspects of this disease are examined with the help of historical sources, newspapers and documents. Ethical Considerations: The Ethical Committee of Department of History, Faculty of Literature and Humanities, Dr.Ali Shariati of Ferdowsi University approved the study. Conclusion: This paper addresses malaria in Fars during Qajar era (1789-1925). It initially emphasizes on pathological importance of malaria history in Iran and then analyzes the role of malaria outbreak as a factor causing human casualties in the southern Iran and Fars.   Cite this article as: Golshani SAR, Nematollahi SR, Sarafrazi A. Malaria in Fars during Qajar Era (1789-1925). Medical History Journal 2020; 12(44): e5

In vitro bioaccessibility, phase partitioning, and health risk of potentially toxic elements in dust of an iron mining and industrial complex

Dust emitted from mining, ore processing, and tailing dumps have direct effects on miners who work close to these operations. The Gol-E-Gohar (GEG) mining and industrial company is one of the most important iron concentrate producers in the Middle East. The objective of the present study was to estimate the distribution, fractionation, and oral bioaccessibility of potentially toxic elements (PTEs) in dust generated by the GEG mining and industrial company. Total PTE content including Al, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Mo, Ni, Pb, V, and Zn was quantified for suspended particulate matter (PM) in PM2.5, PM10, and total suspended particulate matter (TSP). As, Cd, Co, Cu, Fe, Ni, and Pb were quantified in fallout dust samples for oral bioaccessibility using in vitro Unified BARGE (UBM) Method and modified BCR fractionation analysis. Enrichment factors (EF) were calculated for the studied elements in PM; Cu, Fe, and As were found to be extremely enriched. Oral bioaccessibility of selected PTEs in fallout dust samples ranged from 0.35% to 41.55% and 0.06–37.58% in the gastric and intestinal phases, respectively. Regression modeling revealed that the bioaccessibilities of the PTEs could mostly be explained by total concentrations in dust particles. Average daily intake (ADI) calculations revealed that the intake of PTEs did not exceed the tolerable daily intake (TDI) values and as such was not considered a significant risk to workers. Additionally, the hazard quotients (HQ) and carcinogenic risk (CR) values were lower than the acceptable level. This study can provide further risk assessment and management of PTE pollution in occupational environments

Optimal distribution system restoration using PHEVs

Power outages cost billions of dollars every year and jeopardise the lives of hospital patients. Traditionally, power distribution system takes a long time to recover after a major blackout, due to its top-down operation strategy. New technologies in modern distribution systems bring opportunities and challenges to distribution system restoration. As fast response energy resources, plug-in hybrid electric vehicles (PHEVs) can accelerate the load pickup by compensating the imbalance between available generation and distribution system load. This study provides a bottom-up restoration strategy to use PHEVs for reliable load pickup and faster restoration process. The optimisation problem of finding load pickup sequence to maximise restored energy is formulated as a mixed integer linear programming (MILP) problem. Moreover, the coordination between transmission and distribution restoration is developed to efficiently restore the entire system back to normal operating conditions. Simulation results on one 100-feeder test system demonstrate the efficiency of MILP-based restoration strategy and the benefit from PHEVs to restore more energy in given restoration time. The proposed restoration strategy has great potential to facilitate system operators to achieve efficient system restoration plans. It also provides incentives to deploy a large amount of PHEVs to improve system resiliency