A comparison of dexmedetomidine, moxonidine and alpha-methyldopa effects on acute, lethal cocaine toxicity

Background: The treatment of cocaine toxicity is an important subject for emergency physicians. We investigated the effects of dexmedetomidine, moxonidine and alpha-methyldopa on acute cocaine toxicity in mice. Objectives: The aim of this study was to evaluate the effects of dexmedetomidine, moxonidine and alpha-methyldopa in a mouse model of acute cocaine toxicity. Materials and Methods: We performed an experiment consisting of four groups (n = 25 each). The first group received normal saline solution, the second group received 40 μg/kg of dexmedetomidine, the third group received 0.1 mg/kg of moxonidine and the fourth group received 200 mg/kg of alpha-methyldopa, all of which were intraperitoneally administered 10 minutes before cocaine hydrochloride (105 mg/kg). All animals were observed for seizures (popcorn jumping, tonic-clonic activity, or a loss of the righting reflex) and lethality over the 30 minutes following cocaine treatment. Results: The ratio of animals with convulsions was lower in all treated groups when compared to the control (P 0.05). In addition, the time to lethality was also longer in the same group (P < 0.001). Conclusions: The present study provides the first experimental evidence in support of dexmedetomidine treatment for cocaine-induced seizures. Premedication with dexmedetomidine reduces seizure activity in a mouse model of acute cocaine toxicity. In addition, while dexmedetomidine may be effective, moxonidine and alpha-methyldopa did not effectively prevent cocaine-induced lethality. © 2015, Iranian Red Crescent Medical Journal

Full Electrostatic Control of Nanomechanical Buckling

Buckling at the micro and nanoscale generates distant bistable states which can be beneficial for sensing, shape-reconfiguration and mechanical computation applications. Although different approaches have been developed to access buckling at small scales, such as the use heating or pre-stressing beams, very little attention has been paid so far to dynamically and precisely control all the critical bifurcation parameters, the compressive stress and the lateral force on the beam. Precise and on-demand generation of compressive stress on individually addressable microstructures is especially critical for morphologically reconfigurable devices. Here, we develop an all-electrostatic architecture to control the compressive force, as well as the direction and amount of buckling, without significant heat generation on micro/nano structures. With this architecture, we demonstrated fundamental aspects of device function and dynamics. By applying voltages at any of the digital electronics standards, we have controlled the direction of buckling. Lateral deflections as large as 12% of the beam length were achieved. By modulating the compressive stress and lateral electrostatic force acting on the beam, we tuned the potential energy barrier between the post-bifurcation stable states and characterized snap-through transitions between these states. The proposed architecture opens avenues for further studies that can enable efficient actuators and multiplexed shape-shifting devices

Problems encountered in conventional HIV 1/2 Algorithms: lack of necessity for immunoblot assays to confirm repeated ELISA reactive results

Background: The use of conventional (serologically based) HIV 1/2 diagnostic algorithms has become controversial in recent years.Objectives: Sera from patients who underwent verification tests were evaluated because repeated ELISA-reactive results demonstrated a HIV1+HIV2 positive band pattern.Methods: The line immunoassay (LIA) test was used for repeated HIV enzyme immunoassays (EIA)-reactive sera in patients at three centers. The Bio-Rad Geenius™ HIV 1/2 and the HIV-1 RNA tests were used. HIV-1 and RNA HIV-2 were investigated using PCR.Results: LIA was used to evaluate 3,224 out of 10,591 samples with repeated ELISA reactivity (30%). We found that 32 (1%) of the sera, along with HIV1 bands and HIV2 gp36 bands, were positive. Only 28 of the 32 verified serum samples with gp36 bands were repeated, and no gp36 band positivity was detected using the Bio-Rad Geenius™ HIV-1/2 confirmatory assay in these serum samples. The HIV-2 proviral DNAs were also negative. Therefore, we excluded the possibility of HIV1+2 co-infection. All samples from the 32 patients were positive for HIV-1 RNA.Conclusion: Our findings highlight the need to exclude confirmatory tests like the LIA test from the current diagnostic HIV algorithm and replace it with rapid HIV-1 and HIV-2 confirmatory immunochromotographic tests.Keywords: HIV, AIDS, HIV-2

Enabling patient adherence via personalised, just-in time adaptive interventions in ADLIFE architecture

Chronic diseases introduce challenges for the patients to continuously be involved in their care activities and manage the changing requirements of their disease. Patient empowerment activities are a critical component to assist patients in their long-term care journey. In the ADLIFE project (H2020, SC1-DTH-11-2019, 875209), an integrated care planning approach is used where patients are assigned various care plan activities by multidisciplinary care teams. To increase patients’ adherence to the care plan, a continuous behavioral monitoring architecture is developed for delivering digital personalised, just-in time adaptive interventions

Problems encountered in conventional HIV 1/2 Algorithms: lack of necessity for immunoblot assays to confirm repeated ELISA reactive results

Background: The use of conventional (serologically based) HIV 1/2 diagnostic algorithms has become controversial in recent years. Objectives: Sera from patients who underwent verification tests were evaluated because repeated ELISA-reactive results demonstrated a HIV1+HIV2 positive band pattern. Methods: The line immunoassay (LIA) test was used for repeated HIV enzyme immunoassays (EIA)-reactive sera in patients at three centers. The Bio-Rad Geenius\u2122 HIV 1/2 and the HIV-1 RNA tests were used. HIV-1 and RNA HIV-2 were investigated using PCR. Results: LIA was used to evaluate 3,224 out of 10,591 samples with repeated ELISA reactivity (30%). We found that 32 (1%) of the sera, along with HIV1 bands and HIV2 gp36 bands, were positive. Only 28 of the 32 verified serum samples with gp36 bands were repeated, and no gp36 band positivity was detected using the Bio-Rad Geenius\u2122 HIV-1/2 confirmatory assay in these serum samples. The HIV-2 proviral DNAs were also negative. Therefore, we excluded the possibility of HIV1+2 co-infection. All samples from the 32 patients were positive for HIV-1 RNA. Conclusion: Our findings highlight the need to exclude confirmatory tests like the LIA test from the current diagnostic HIV algorithm and replace it with rapid HIV-1 and HIV-2 confirmatory immunochromotographic tests

The design of a mobile platform providing personalized assistance to older multimorbid patients with mild dementia or mild cognitive impairment (MCI)

Management of multiple chronic conditions introduces demanding challenges for patients. This situation becomes more complex when multimorbidity is associated with dementia. In this paper, we present the design of a mobile Patient Empowerment Platform that enables older multimorbid patients with mild dementia or mild cognitive impairment (MCI) to easily follow their complex care plans and increase their adherence. We focus on the presentation of the human-centered design process that we have followed with the involvement of patients, informal caregivers, and healthcare professionals via the clinical pilot sites of the CAREPATH project. We elaborate the design challenges we have faced and present the iterative mock-ups that have been created in cooperation with end users to address these challenges and the final PEP design

Protocol for creating a single, holistic and digitally implementable consensus clinical guideline for multiple multi-morbid conditions

Delivery of future healthcare information systems requires systems to support patients with multi-morbidity. Current approaches to computer interoperable guidelines typically consider only a single clinical guideline for a single condition. There is a need to establish a robust protocolized approach to the development of holistic consensus computer interoperable guidelines in the context of multi-morbidity. The presence of mild cognitive impairment (MCI) and dementia adds an additional challenge to the delivery of effective digital health solutions. CAREPATH proposes an ICT-based solution for the optimization of clinical practice in the treatment and management of multi-morbid older adults with mild cognitive impairment or mild dementia. In this manuscript, we present an evidence-based protocol for the development of a single computer interoperable holistic guideline for a collection of multi-morbid conditions. To the best of our knowledge, this is the first published protocol for the production of a consensus interoperable clinical guideline for people with multi-morbidity, with special focus on older adults with MCI or mild dementia. This addresses a still unmet need for such processes which are expected to play a central role for future integrated healthcare information systems

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries