Comparison of Remifentanil and Alfentanil Bolus Dose on Extubation Emergence Hemodynamic Profiles, a Randomized Double-blinded Placebo-Controlled Trial

Background: Hemodynamic instability is common during emergence from anesthesia which predisposes patients to development of different side effects. The primary purpose of the present study is to evaluate the effect of Remifentanil and Alfentanil on the hemodynamic profiles during and after extubation.Methods: Ninety-nine patients aged 20-50 years undergoing minor orthopedic surgery under general anesthesia were randomly allocated into control, Remifentanil and Alfentanil groups. Before extubation patients received Remifentanil (1 μg/kg), or Alfentanil (10 μg/kg) or 5 mL of Saline as a placebo based on their group. Baseline heart rate (HR), mean arterial pressure (MAP) plus systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded and documented again on extubation, and 1, 3 and 5 minutes after extubation. Cough status before and after extubation was recorded.Results: The basic characteristics of participants in all the three groups were similar. The rise in SBP on extubation in the placebo group was statistically significant compared to the Alfentanil (p=0.01) and the Remifentanil (p<0.001) groups. Mean arterial pressure decreased during the extubation in group R (97.0±13 mmHg) in contrast to other two groups (A=101.9±13 mmHg, P=101.4±13 mmHg). Heart rate increased in group A and P contrary to group R on extubation.Conclusion: Remifentanil (1μg/kg) and Alfentanil (10μg/kg) attenuate the rise in SBP on extubation but no significant changes were seen between these two drugs

The Effect of Premedication by Remifentanil and Magnesium Sulfate in Hemodynamic Responses to Tracheal Intubation in Cesarean Section Delivery: 1 A Randomized Double-Blinded Controlled Study

Background: The preventing effects of remifentanil and magnesium sulfate on hemodynamic responses to tracheal intubation were evaluated in a double-blinded controlled trial on pregnant women undergoing cesarean section delivery.Methods: A total of 54 American Society of Anesthesiologists Class I-II women candidate for cesarean section delivery were randomly assigned to one of three groups (n = 18) to receive one of the following premedication: Intravenous (IV) remifentanil 0.75 µg/kg, IV magnesium sulfate 30 mg/kg, or IV normal saline 10 cc as placebo. All hemodynamic profiles were recorded immediately before and after intubation, and 2, 3, 5 minutes after tracheal intubation.Results: Heart rate and systolic and diastolic blood pressures were significantly lower in the remifentanil group than in other groups both before and immediately after intubation. The trend of the changes in homodynamic responses within 5 minutes following intubation in the magnesium sulfate and placebo group was similar, but this trend in the remifentanil group was significant difference. In the same time, 1st and 5th minute Apgar scores were slightly lower in the remifentanil group than others. The measured parameters of umbilical cord blood pH and PO had no significant differences between the groups.Conclusions: Remifentanil can attenuate hemodynamic response to tracheal intubation more effectively than magnesium sulfate, and thus it can be considered safe for a pregnant candidate for cesarean section

Plethysmography Variability Index as a Guidance for Intraoperative Fluid Management in Cesarean Section Delivery under Spinal Anesthesia: A Pilot Study

Background: Plethysmography variability index (PVI) is a measure of the dynamic changes in the perfusion index (PI) that occur during one or more complete respiratory cycles. This study was designed to investigate the accuracy of PVI in guidance of fluid management in parturient undergoing cesarean section surgery under spinal anesthesia.Methods: This randomized clinical trial was performed on 21 consecutive patients who were candidate for cesarean section surgery under spinal anesthesia at Shariati Hospital in Tehran, Iran, between April 2015 and April 2016. The patients were randomly assigned to one of the PVI or conventional group. In all patients, serum level of lactate, mean arterial pressure (MAP), total amount of infused intraoperative fluids, urine output, and duration of surgery were recorded.Results: In total, 21 patients (10 in PVI group and 11 in control group) were assessed. The trend of the change in MAP was significantly different between the two groups with a downward trend in PVI group and a fluctuated trend in the conventional group (P = 0.003). The mean amount of infused fluid was 2565.00 ± 563.74 ml in PVI group that was significantly lower than control group (3122.73 ± 321.99 ml) (P = 0.011). Although urine output was numerically higher in PVI than in control group (425.00 ± 274.12 ml vs. 322.00 ± 121.82 ml), it was not statistically significant (P = 0.292). In PVI group, the primary value of PVI was 23.80 ± 6.93 that reached to 12.20 ± 1.75 at the end of surgery indicating a significant reduction (P < 0.001).Conclusions: Regarding clinical and hemodynamic stability as well as fluid therapy responsiveness (less requiring fluids within surgery), PVI monitoring seems to be superior to the conventional method

Immunochemical Characterization of Prosopis Juliflora Pollen Allergens and Evaluation of Cross-Reactivity Pattern with the Most Allergenic Pollens in Tropical Areas

Allergy to Prosopis juliflora (mesquite) pollen is one of the common causes of respiratory allergy in tropical countries. Mesquite is widely used as street trees in towns and ornamental shade trees in parks and gardens throughout arid and semiarid regions of Iran. The inhalation of mesquite pollen and several species of Amaranthus/Chenopodiaceae family is the most important cause of allergic respiratory symptoms in Khuzestan province. This study was designed to evaluate IgE banding proteins of mesquite pollen extract and its IgE cross-reactivity with other allergenic plants. Twenty patients with allergic symptoms and positive skin prick tests (SPT) for mesquite pollen extract participated in the study. Crude pollen extract was prepared from local mesquite trees and used for the evaluation of allergenic profiles of P. juliflora pollen extract by Sodium dodecylsulfate polyacrylamide gel electrophoresis (SDS-PAGE) and IgE-immunoblotting. There were several protein bands in mesquite pollen extract using SDS-PAGE with the approximate range of molecular weight of 10-85 kDa. The most frequent IgE reactive bands among the patients' sera were approximately 20 and 66 kDa. However, there were other IgE reactive protein bands among the patients' sera with molecular weights of 10, 15, 35, 45, 55 and 85 kDa. Inhibition experiments revealed high IgE cross-reactivity between mesquite and acacia. There are several IgE-binding proteins in P. juliflora pollen extract. Results of this study indicate that proteins with a molecular weight of 10 to 85 kDa are the major allergens in P. juliflora pollen extract

Impact of Wikipedia on citation trends

It has been suggested that the "visibility" of an article influences its citation count. More specifically, it is believed that the social media can influence article citations.Here we tested the hypothesis that inclusion of scholarly references in Wikipedia affects the citation trends. To perform this analysis, we introduced a citation “propensity” measure, which is inspired by the concept of amino acid propensity for protein secondary structures. We show that although citation counts generally increase during time, the citation "propensity" does not increase after inclusion of a reference in Wikipedia

Phenotype and genetic determination of resistance to common disinfectants among bioflm-producing and non-producing Pseudomonas aeruginosa strains from clinical specimens in Iran

Background: Pseudomonas aeruginosa is a common pathogen in Hospitalized patients, and its various resistance mechanisms contribute to patient morbidity and mortality. The main aims of the present study were to assess the susceptibility of bioflm-producing and non-producing P. aeruginosa isolates to the fve commonly used Hospital disinfectants, to evaluate the synergistic efect of selected disinfectants and Ethylene-diamine-tetra acetic acid (EDTA), and the efect of exposure to sub-inhibitory concentrations of Sodium hypochlorite on antimicrobial susceptibility test. Results: The results showed that sodium hypochlorite 5% and Ethanol 70% were the most and least efective disinfectants against P. aeruginosa, respectively. The addition of EDTA signifcantly increased the efectiveness of the selected disinfectants. The changes in the antibiotic-resistance profles after exposure to sub-inhibitory concentrations of disinfectants were observed for diferent classes of antibiotics (Carbapenems, Aminoglycosides, Cephalosporins, Fluoroquinolones). As well as near the all isolates harbored efux pump genes and 117 (97.5%) of isolates produced bioflm. Conclusion: In the current study, the mixture of disinfectant and EDTA were the most suitable selection to disinfect Hospital surfaces and instruments. Also, it was clear that exposure to sub-inhibitory concentrations of Sodium hypochlorite results in resistance to some antibiotics in P. aeruginosa species. Strong and intermediate bioflm formers belonged to MDR/XDR strains. Future studies should include more complex microbial communities residing in the Hospitals, and more disinfectants use in Hospitals. Keywords: Nosocomial infection, Disinfectant-resistance, Bioflm, Hospital disinfectants, Pseudomonas aeruginosa, Clinical isolate

Identifications of part families and bottleneck parts in celluar manufacturing

Group technology (GT) has emerged as an important scientific philosophy in improving the productivity of manufacturing systems. GT philosophy offers a systems approach to the reorganization of traditional complex job shop and flow shop  manufacturing systems into cellular or flexible manufacturing systems. The main objective of this philosophy is to achieve benefits for manufacturing systems. For implementation of this method the formation of machine-part families is an important task in the design of cellular and flexible manufacturing systems. The formation results in the creation of many benefits for manufacturing systems. Among the many methods utilized in machine cells formation, the similarity coefficient method(SCM) is most widely used. When SCM is used. th

A consideration of tourism education a three - domain approach

The Supply of tourism courses has grown considerably over the past three decades. Such growth has been fuelled by the rapid expansion of the industry and recognition by governments that tourism contributes significantly to local and national economies. The article raises critical questions that tourism stakeholders need to acknowledge if tourism , both as an industry and as a Iiele of study , is to sustain itself in the long term. To meet the evolving needs of stakeholders , this article proposes that tourism education should become more specialists in nature . The authors farward a three• domain model of tourism education based on generic , functional , and product I market - based themed degree routes. The article outlines a cost I benefig analysis of consideration of tourism education for the key stakeholders and puts forward an action plan for its implementation

Attenuation of Hemodynamic Responses to Intubation by Gabapentin in Coronary Artery Bypass Surgery: a Randomized Clinical Trial

A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety  verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4,  respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG

Drug resistance in Vibrio cholerae strains isolated from clinical specimens

Cholera is a serious epidemic and endemic disease caused by the Gram-negative bacterium Vibrio cholerae. SXT is an integrative conjugation element (ICE) that was isolated from a V. cholerae; it encodes resistance to the antibiotics chloramphenicol, streptomycin and sulfamethoxazole/trimethoprim. One hundred seven V. cholerae O1 strains were collected from cholera patients in Iran from 2005 to 2007 in order to study the presence of SXT constin and antibiotic resistance.The study examined 107 Vibrio cholerae strains isolated from cholera prevalent in some Iranian provinces. Bacterial isolation and identification were carried out according to standard bacteriological methods. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) to four antibiotics (chloramphenicol, streptomycin, sulfamethoxazole, and trimethoprim) were determined by broth microdilution method. PCR was employed to evaluate the presence of established antibiotic resistance genes and SXT constin using specific primer sets.The resistance of the clinical isolates to sulfamethoxazole, trimethoprime, chloramphenicol, and streptomycin was 97%, 99%, 99%, and 90%, respectively. The data obtained by PCR assay showed that the genes sulII, dfrA1, floR, strB, and sxt element were present in 95.3%, 95.3%, 81.3%, 95.3%, and 95.3% of the V. cholerae isolates.The Vibrio strains showed the typical multidrug-resistance phenotype of an SXT constin. They were resistant to sulfamethoxazole, trimethoprime, chloramphenicol, and streptomycin. The detected antibiotic resistance genes included dfrA for trimethoprim and floR, strB, sulII and int, respectively, for chloramphenicol, streptomycin, sulfamethoxazole, as well as the SXT element