Dexmedetomidine versus propofol: An effective combination with ketamine for adult procedural sedation: A randomized clinical trial.

BACKGROUND: Recently, drug combination protocols have been preferred over single drugs in procedural sedation and analgesia (PSA). This study aimed to compare the effectiveness and hemodynamic profile of ketamine-dexmedetomidine (ketodex) and ketofol as drug combinations with ketamine as a single medication for PSA in the emergency department (ED). METHODS: This prospective, randomized, double-blind clinical trial was performed among adult patients (≥18 years) requiring PSA for a painful procedure in the ED. 135 patients were enrolled and assigned into three equal groups to receive either ketodex, ketofol, or ketamine. Additional ketamine was used as a rescue agent for inadequate sedation in three groups. Oxygen saturation, heart rate, and blood pressure were recorded from baseline until 120 min after induction of PSA. Adverse events, hemodynamic variables, induction, and recovery time were recorded and compared between groups. RESULTS: The mean age of the patients was 38.16 ± 19.09 years and no differences were observed between the three groups in terms of demographic variables, pain scores, and procedures between the three groups. Respiratory events had similar incidences between the three groups. The O2 reduction was less in the Ketodex group in comparison with Ketofol and Ketamine groups (1.9%, 6.5%, and 3.8%, P = 0.015). No patient needed endotracheal intubation. Changes in mean arterial pressure from the baseline in Ketamine and Ketofol groups compared to Ketodex was higher (difference was 12.9 mmHg [95% CI, 9.5 to 20.3] and 8.6 mmHg [95% CI, 3.4 to 13.7]. Tachycardia in the Ketamine group had a significantly higher incidence. The recovery time was statistically shorter in the Ketofol group in comparison with other groups. The differences between Ketofol with Ketamine and Ketodex groups were 9.8 min (95% CI, [2.5 to 17.1]) and 8.3 min (95% CI, [1.5 to 15.1]). CONCLUSION: Ketodex, as well as ketofol, were effective and safe combinations with good recovery profiles and hemodynamic stability for adult PSA in ED.

Benefits of negative pressure wound therapy with fat migration during revisional total hip arthroplasty in an obese patient: A case report.

INTRODUCTION: A 38-year-old African American woman presented with right hip pain and movement restriction. Her medical history included a right hip and knee arthroplasty 10 years prior, history of Slipped Capital Femoral Epiphysis and osteonecrosis of the hip. Preoperative assessment was significant for multiple comorbidities such as obesity (BMI > 38), hypertension, asthma. PATIENT CONCERNS: The patient presented with right hip pain, rated 7/10, and restricted hip flexion, adduction, and abduction. DIAGNOSIS: Recent imaging showed eccentric deterioration of the polyethylene lining of her prosthesis, acetabular hypertrophy on her right hip prosthesis, and chronic deformity of the pubic bone. INTERVENTIONS: Based on these findings, a revisional total hip arthroplasty was performed. After the surgical procedure, the WoundVAC and the percutaneous drain were applied outside the tensor fascia lata to reduce seroma and hematoma formation. Postoperative pain control, antibiotics and DVT prophylaxis were given. On post-op day 3, an irrigation and debridement with delayed primary wound closure was performed under sterile conditions. OUTCOMES: On postoperative assessment, the wound demonstrated adequate healing without any signs of infection. Sutures and staples were removed 4 weeks post-op. Upon palpation there was no edema, effusions, temperature changes, tenderness. Clinical inspection revealed symmetrical alignment of the pelvis and hips. Range of motion testing revealed restriction beyond 80 degrees upon flexion and beyond 5 degrees of adduction and 10 degrees of abduction. The surgical site was noted to be healed at 6 weeks post-op. The patient continued to do well to date, without exacerbations. CONCLUSION: Obesity increases the risk of post-operative complications and wound healing failure. Therefore, Vacuum-assisted wound closure (WoundVAC), a type of negative pressure wound therapy, was applied outside the tensor fascia lata post-operatively, where the surgical incision was made. Negative pressure wound therapy facilitates wound healing by stimulating angiogenesis and promoting granulation tissue formation, which in turn can reduce the risk of surgical site infection in obese patients undergoing total hip arthroplasty. Highlighted is the mechanism of fat migration in the promotion of wound healing after preoperative weight loss and exercise.

Formulation of Aflatoxins B1 & B2 reduction in corn by low level gamma irradiation.

Corn is one of the main food items for humans and animals. Contamination of corn with aflatoxin during harvest, storage, and transport is one of the human problems. Different methods for removing and inactivating aflatoxin in corn have been introduced so far. In this research, using the gamma radiation caused by radioactive granite, the reduction of corn aflatoxin was investigated with practical and simulation methods. In a practical method by simulation result, the aflatoxin reduction as a function of time and granite gamma radiation dose in corn were calculated. The simulation was done with the Mont Carlo N-Particle X version (MCNPX) code that based on the Monte Carlo method. Results show that the relationship between the percentage of aflatoxin reduction and the irradiation time (t (day)) is 0.017 × t. Due to the low-level gamma dose of granite, the percentage of protein, fat, and vitamins in corn does not change with granite irradiation. Therefore, the results show that the use of low granite gamma radiation to reduce aflatoxin can improve physicochemical properties, reduce aflatoxin levels and increase the antioxidant properties of corn, which has ultimately reduced the risk of developing cancer caused by aflatoxin.

Determinants of completion of cancer directed treatment: an experience from a rural cancer centre, Sangrur, Punjab state, India.

In low and middle-income countries, access to cancer diagnosis and treatment is suboptimal. Further, compliance to cancer treatment is a major issue due to various reasons including financial barriers, lack of family support and fear of treatment. This article discusses the determinants of treatment completion in cancer patients of a government-run hospital, in a rural part of Punjab in India. The Sangrur hospital-based cancer registry data for the year 2018 have been used. We have registered 2,969 cancer cases, out of which 2,528 (85%) cases were eligible for the analysis. Of the total 2,528 cases, 1,362 (54%) cases completed the cancer directed treatment and 1,166 (46%) did not. The data have been collected from the electronic medical record (EMR) department and entered into CanReg5 software. The bivariate and multivariate binary logistic regression analysis was performed to see the effect of variables on the treatment completion. The results indicate that the elderly age group (>60 years) (odds ratio (OR): 0.52, (95% confidence interval (CI): 0.31-0.86)), distance from hospital (OR: 0.67, (95% CI: 0.50-0.89)) and access to government health schemes (OR: 0.13, (95% CI: 0.10-0.19)] have direct correlation with the treatment completion. The educated patients (OR: 1.49, (95% CI: 1.13-1.96)) and patients who received curative treatment (OR: 2.7, (95% CI: 1.88-3.88)) have shown 58% and 84% compliance to treatment completion, respectively. The other variables like the clinical extent of disease, religion, gender and income do not have any significant effect on the treatment completion. Determinants like age (young), education, distance from the hospital, curative treatment and availability of government health schemes for financial support have shown positive effects on treatment completion. These factors have to be considered by the cancer hospitals, health departments and policymakers while planning for cancer care or control in India.

Hepatitis C and HIV incidence and harm reduction program use in a conflict setting: an observational cohort of injecting drug users in Kabul, Afghanistan.

BACKGROUND: Armed conflict may increase the risk of HIV and other pathogens among injecting drug users (IDUs); however, there are few prospective studies. This study aimed to measure incidence and potential predictors, including environmental events and needle and syringe distribution and collection program (NSP) use, of hepatitis C virus (HCV) and HIV among IDUs in Kabul, Afghanistan. METHODS: Consenting adult IDUs completed interviews quarterly in year 1 and semi-annually in year 2 and HCV and HIV antibody testing semi-annually through the cohort period (November 2007-December 2009). Interviews detailed injecting and sexual risk behaviors, NSP service use, and conflict-associated displacement. Quarters with peak conflict or local displacement were identified based on literature review, and key events, including insurgent attacks and deaths, were reported with simple counts. Incidence and predictors of HCV and HIV were measured with Cox proportional hazards models. RESULTS: Of 483 IDUs enrolled, 385 completed one or more follow-up visits (483.8 person-years (p-y)). All participants were male with a median age of 28 years and a median duration of injecting of 2 years. Reported NSP use among the participants ranged from 59.9 to 70.5 % in the first year and was 48.4 and 55.4 % at 18 and 24 months, respectively. There were 41 confirmed deaths, with a crude death rate of 93.4/1000 p-y (95 % confidence interval (CI) 67.9-125) and overdose as the most common cause. HCV and HIV incidence were 35.6/100 p-y (95 % CI 28.3-44.6) and 1.5/100 p-y (95 % CI 0.6-3.3), respectively. Changing from injecting to smoking was protective for HCV acquisition (adjusted hazard ratio (AHR) = 0.53, 95 % CI 0.31-0.92), while duration of injecting (AHR = 1.09, 95 % CI 1.01-1.18/year) and sharing syringes (AHR = 10.09, 95 % CI 1.01-100.3) independently predicted HIV infection. CONCLUSION: There is high HCV incidence and high numbers of reported deaths among male Kabul IDUs despite relatively consistent levels of harm reduction program use; peak violence periods did not independently predict HCV and HIV risk. Programming should increase awareness of HCV transmission and overdose risks, prepare clients for harm reduction needs during conflict or other causes of displacement, and continue efforts to engage community and police force support.

Hautriwaic acid as one of the hepatoprotective constituent of Dodonaea viscosa.

It is widely known that hepatitis and its complications such as cirrhosis or hepatocellular carcinoma are one of the major health problems of the world especially since no specific treatment is available. In the present study we investigated the hepatoprotective potential of the methanolic extract of the whole plant of Dodonaea viscosa and its ethyl acetate, aqueous, butanol and n-hexane fractions against carbon tetrachloride (CCl4) induced hepatoxicity in rats. Hepatoprotection was assessed in terms of reduction in serum enzymes (ALT, AST, and ALP) that occur after CCl4 injury, and by histopathology and immunohistochemistry. The methanolic extract reduced the serum enzyme level (ALT, AST, and ALP) down to control levels despite CCl4 treatment. It also reduced the CCl4-induced damaged area to 0% as assessed by histopathology. The CD68+ macrophages were also reduced in number around the central vein area by the methanolic extract. These hepatoprotective effects were better than the positive control silymarin. Similar hepatoprotective activities were found with the ethyl acetate, and aqueous fractions of the methanolic extract. The butanol and n-hexane fractions showed elevated levels of ALT, AST and ALP as compared to the positive control silymarin. Histopathology showed ∼30% damage to the liver cells with the butanol and n-hexane fractions which still showed some protective activity compared to the CCl4 treated control. HPLC fingerprinting suggested that hautriwaic acid present in the methanolic extract and its ethyl acetate, and aqueous fractions may be responsible for this hepatoprotective activity of Dodonaea viscosa which was confirmed by in vivo experiments.

Non-rheumatic annular mitral stenosis: prevalence and characteristics.

AIMS: To define the prevalence and characteristics of non-rheumatic annular mitral stenosis (AMS) in a general population as compared with rheumatic mitral stenosis (RMS). METHODS AND RESULTS: Clinical and echocardiographical variables were assessed in 70 patients with mitral stenosis. AMS and RMS patients were age- and gender-matched for the comparison of echocardiographic variables. Thirteen patients (18.5%) had AMS. Arterial hypertension and hypercholesterolemia were more prevalent in AMS (77 vs. 36% and 75 vs. 27%, respectively, P<0.05). Mitral annulus calcification severity score (2.2 vs. 1.3, P<0.05) and left ventricular mass (276+/-73 vs. 209+/-57 g, P<0.05) were significantly higher in AMS. Mitral valve area (MVA) was higher and mean gradient was lower (2.25+/-0.6 vs.1.9+/-0.6 cm2, 4+/-1.2 vs. 5.6+/-3.5 mmHg, P=ns) in AMS. Pressure half-time (PHT) MVA and planimetry MVA had a better correlation in RMS than in AMS patients (r=0.98 vs. 0.71, P<0.05). CONCLUSION: AMS is more frequent than that is assumed and is associated with risk factors for coronary artery disease. AMS is generally mild and PHT may be less accurate for MVA calculation than in RMS.

Standardization of trauma symptoms checklist for children / Normatização da escala de sintomas de trauma para crianças / Normatizacion de la escala de sintomas de trauma para niños

The aim of this study was to standard and assign validity and reliability of the Trauma Symptom Checklist for Children - TSCC-A. Normative data for the TSCC-A were based on 3.042 students participating in a prevalence child abuse study in 19 different loca-tions of Tehran and 140 participants who had been referred to the run away children cen-ters in Tehran. After the TSCC was validat ed on run away and abused children, it was made available to researchers doing larger studies on normative group. Reliability analysis of the TSCC-A scales in the normative sample demonstrated high internal consistency. The evidence for its validations (convergent, discriminate and construct validity) showed that they were significantly acceptable. This paper presents data demonstrating the psychometric reliability and validity of the TSCC-A scales in Iranian student population. We suggest to include the TSCC-A in a battery of relevant standardized tests

O objetivo deste estudo foi normatizar e estudar a confiabilidade e validade da Escala de Sintomas de Trauma para Crianças - Trauma Symptom Checklist for Children(TSCC-A). Os dados normativos para a TSCC-A foram baseados em 3.042 estudantes que participaram de um estudo sobre prevalência de abuso infantil que abrangeu 19 cidades diferentes de Teerã e 140 participantes que haviam fugido de instituições para crianças de Teerã. Depois que o TSCC foi validado em crianças que sofreram abuso e que fugiram, ele foi disponibiliza - do aos pesquisadores que fazem estudos maiores com grupo normativo. A análise de confiabilidade da escala TSCC-A na amostra normatizada mostrou uma alta consistência interna. As evidências para essa validação (convergência, discriminação e validade de construto) mostraram que foram aceitas significativamente. Este artigo apresenta dados demonstrando a con - fiabilidade e a validade psicom étrica da escala TSCC-A na população de estudantes iranianos. Sugere-se incluir a escala TSCC-A na categoria de bateria de testes normatizados.

El objetivo de este estudio fué normatizar y estudiar la confiabilidad y validad de la Escala de Síntomas de Trauma para Niños - Trauma Symptom Checklist for Children(TSCCA). Los datos normativos para la TSCC-A fueron basados en 3.042 estudiantes que participaron en un estudio sobre prevalencia de abuso infantil que abarcó 19 ciudades diferentes de Teheran y 140 participantes que habían huído de instituições para crianças de Teheran. Después que la TSCC fué validada en niños que sufrieron abuso y que huyeron, el mismo fué disponibilizado a los investigadores que hacen estudios mayores con grupo normativo. El análisis de confiabilidad de la escala TSCC-A en la muestra normatizada mostró una alta consistencia interna. Las evidencias para esta validación (convergencia, discriminación y validad de construc - to) mostraron que fueron aceptas significativamente. Este artículo presenta datos demostrando la confiabilidad y validad psicométrica de la escala TSCC-A en la población de estudiantes iranianos. Se sugiere incluir la escala TSCC-A en la categoría de batería de tests normatizados.