Investigation into the effects of hydrophobicity on thermohydraulic characteristics and entropy generation of hybrid nanofluid with the magnetic property in a micro-heat sink under a magnetic field.

The cooling of devices is a big challenge in the electronics industry, and most process units (graphical are central process units) experience defects under harsh temperature conditions, so dissipating generated heat under various working conditions should be studied seriously. This study investigates the magnetohydrodynamics of hybrid ferro-nanofluids in the presence of hydrophobic surfaces in a micro-heat sink. To scrutinize this study, a finite volume method (FVM) is applied. The ferro-nanofluid includes water as a base fluid and multiwall carbon nanotubes (MWCNTs) and Fe3O4as nanoadditives, which are used in three concentrations (0, 1, and 3%). Other parameters such as the Reynolds number (5-120), Hartmann number (magnitude of the magnetic field from 0 to 6), and hydrophobicity of surfaces are scrutinized for their impacts on heat transfer and hydraulic variables as well as entropy generation variables. The outcomes indicate that increasing the level of hydrophobicity in surfaces leads simultaneously to improved heat exchange and reduced pressure drop. Likewise, it decreases the frictional and thermal types of entropy generation. Intensifying the magnitude of the magnetic field enhances the heat exchange as much as the pressure drop. It can also decrease the thermal term in entropy generation equations for the fluid, but increase the frictional entropy generation and adds a new term, magnetic entropy generation. Incrementing the Reynolds number improves the convection heat transfer parameters, although it intensifies the pressure drop in the length of the channel. Also, the thermal entropy generation and frictional entropy generation decrease and increase with an increasing flow rate (Reynolds number).

Deep PUF: A Highly Reliable DRAM PUF-Based Authentication for IoT Networks Using Deep Convolutional Neural Networks.

Traditional authentication techniques, such as cryptographic solutions, are vulnerable to various attacks occurring on session keys and data. Physical unclonable functions (PUFs) such as dynamic random access memory (DRAM)-based PUFs are introduced as promising security blocks to enable cryptography and authentication services. However, PUFs are often sensitive to internal and external noises, which cause reliability issues. The requirement of additional robustness and reliability leads to the involvement of error-reduction methods such as error correction codes (ECCs) and pre-selection schemes that cause considerable extra overheads. In this paper, we propose deep PUF: a deep convolutional neural network (CNN)-based scheme using the latency-based DRAM PUFs without the need for any additional error correction technique. The proposed framework provides a higher number of challenge-response pairs (CRPs) by eliminating the pre-selection and filtering mechanisms. The entire complexity of device identification is moved to the server side that enables the authentication of resource-constrained nodes. The experimental results from a 1Gb DDR3 show that the responses under varying conditions can be classified with at least a 94.9% accuracy rate by using CNN. After applying the proposed authentication steps to the classification results, we show that the probability of identification error can be drastically reduced, which leads to a highly reliable authentication.

Demographic and obstetric factors affecting women's sexual functioning during pregnancy.

BACKGROUND: Sexual desire and frequency of sexual relationships during pregnancy remains challenging. This study aimed to assess factors that affect women's sexual functioning during pregnancy. METHODS: This was a cross sectional study carried out at prenatal care clinics of public health services in Iran. An author-designed structured questionnaire including items on socio-demographic characteristics, obstetric history, the current pregnancy, and women's sexual functioning during pregnancy was used to collect data. The generalized linear model was performed in order to find out factors that affect women's sexual functioning during pregnancy. RESULTS: In all, 518 pregnant women participated in the study. The mean age of participants was 26.4 years (SD = 4.7). Overall 309 women (59.7%) scored less than mean on sexual functioning. The results obtained from generalized linear model demonstrated that that lower education, unwanted pregnancy, earlier stage of pregnancy, older age, and longer duration of marriage were the most important factors contributing to disturbed sexual functioning among couples. CONCLUSION: The findings suggest that sexual function during pregnancy might be disturbed due to several factors. Indeed issues on sexual relationship should be included as part of prenatal care and reproductive health programs for every woman.

Coupling of solvent-based de-emulsification dispersive liquid-liquid microextraction with high performance liquid chromatography for simultaneous simple and rapid trace monitoring of 2,4-dichlorophenoxyacetic acid and 2-methyl-4-chlorophenoxyacetic acid.

A simple, rapid, and efficient sample pretreatment technique, based on solvent-based de-emulsification dispersive liquid-liquid microextraction (SD-DLLME), followed by high performance liquid chromatography (HPLC) has been developed for simultaneous preconcentration and trace detection of 2,4-dichlorophenoxyacetic acid (2,4-D) and 2-methyl-4-chlorophenoxyacetic acid (MCPA) in water and urine samples. Some parameters such as acidity of solution, the amount of salt, type, and volume of extraction solvents, type of disperser/de-emulsifier solvent, and its volume were investigated and optimized. Under optimum extraction conditions, the limits of detections (LODs) of this method for MCPA and 2,4-D were 0.2 and 0.6 µg L(-1) (based on 3S(b)/m) in water and 0.4 and 1.6 µg L(-1) in urine, respectively. Furthermore, dynamic linear range of this method for MCPA and 2,4-D was 1-300 and 2-400 µg L(-1), repectively. Finally, the applicability of the proposed method was evaluated by extraction and determination of the herbicides in urine and different water samples.

Nurses' bereavement experiences of a deceased colleague due to COVID-19: A phenomenological study.

AIM: Healthcare workers have little time to mourn due to the intensification of the COVID-19 pandemic. Although grief is a normal part of life and death, the circumstances surrounding the death can affect the grieving process. So far, the nurses' experience in mourn for a deceased colleague in the COVID-19 pandemic has not been determined. Identifying these experiences can provide opportunities to formulate appropriate strategies to functionally adapt to death and promote mental health and well-being during this crisis. This study aimed to understand the nurses' experiences in mourning for a deceased colleague due to COVID-19. DESIGN: This was an interpretive phenomenological study. METHOD: Participants included 10 nurses with the bereavement experience following the death of a colleague due to COVID-19, who were selected through purposive sampling, and the data were collected through in-depth and semi-structured interviews and analysed using Diekelmann et al.'s (1989) approach. RESULTS: The nurses' bereavement experiences were in the form of eight themes: disbelief and amazement, acceptance with grief, lasting sadness, unsung laments, bringing back memories, impulse to leave the service, a professional myth and holy death. For nurses, mourning for the death of a colleague due to COVID-19 is like a lasting sadness that begins with disbelief and amazement and changes to acceptance with sadness. From the fellow nurses' point of view, this type of death was perceived as a holy death, which along with countless unsung laments and memories brought to us the association of a professional legend, and that such a fate would be inevitable for us as well, it was a push to leave the service. PUBLIC CONTRIBUTION: Crisis managers and policymakers need to add protocols and training programs for resilience skills and healthy mourning.

A Comparative Study on the Effect of Intrathecal Bupivacaine vs. Ropivacaine on Maternal and Neonatal Outcomes After Cesarean Section: A Systematic Review and Meta-analysis.

Context: The type of anesthesia in cesarean section can affect the mother and baby. This study aimed to determine the comparative effect of intrathecal hyperbaric bupivacaine vs. hyperbaric ropivacaine on maternal and neonatal outcomes after cesarean section. Evidence Acquisition: PubMed, Web of Science, Embase, Google Scholar, IranDoc, MagIran, and Scopus databases were searched from 1 September 2022 to 1 November 2022. Eighteen clinical trials with 1542 patients were included in the analysis. Results: There was no statistically significant difference in hypotension, bradycardia, and Apgar score between the 2 groups (P > 0.05). The risk of nausea (relative risk (RR), 1.526; 95% CI, 1.175 - 1.981; P = 0.001) and vomiting (RR, 1.542; 95% CI, 1.048 - 2.268; P = 0.02) caused by bupivacaine was 0.53% and 0.54% higher than that of ropivacaine. The incidence of shivering (RR, 2.24; 95% CI, 1.480 - 3.39; P = 0.00) was 2.24 times higher in the bupivacaine group than in the ropivacaine group. The average onset time of sensory block (standardized mean difference (SMD), -0.550; 95% CI, -1.054 to -0.045; P = 0.032) and motor block (SMD, -0.812; 95% CI, -1.254 to -0.371; P = 0.000) was significantly lower in the bupivacaine group than in the ropivacaine group. Conclusions: Despite the fact that ropivacaine and bupivacaine are effective in cesarean section, ropivacaine is more favorable because of less hemodynamic changes, less duration of sensory and motor block, and fewer side effects, which are effective in patient recovery.

Factors affecting decision-making for knee arthroplasty in patients with osteoarthritis.

OBJECTIVE: Identifying factors affecting decision-making for knee arthroplasty in patients with knee osteoarthritis is critically important for pain relief, improving in knee function and reaching an optimal outcome. When decision-making is hurried or delayed, surgery may not occur in time, which complicates the surgery and increases its complications. This study was conducted to investigate the factors influencing decision-making for knee arthroplasty. METHODS: This study is a qualitative study and inductive content analysis method. This study enrolled 22 patients undergoing knee arthroplasty selected through purposive sampling. Data were collected through semi-structured in-depth interviews and analyzed using inductive content analysis. RESULTS: Data analysis yielded three categories: hope to return to normal life, encouragement and recommendations, and trust and assurance. CONCLUSION: To make better treatment-related decisions and achieve better outcomes based on the patient's values and wishes, it is necessary for the treatment team to increase its interactions and establish stronger communication with patients to make their expectations more realistic and help them understand the risks. They should also make efforts to increase patients' knowledge about the advantages and disadvantages of surgery and clarify what is important to them in decision-making.

Emergency contraception: knowledge, attitudes and practices among married Malay women staff at a public university in Malaysia.

There is a high rate of unintended pregnancies in Malaysia due to low contraceptive use. Only 30% of married women use modern contraceptive methods. Emergency contraception (EC) is used within a few days of unprotected sex to prevent pregnancy. The purpose of this study was to investigate the knowledge, attitudes, and practices regarding EC pill use among Malay women. A cross sectional study was conducted among married female staff using stratified random sampling from 15 faculties in the Universiti Putra Malaysia (UPM). Data about sociodemographic factors, reproductive health, knowledge, attitudes and practices regarding EC use were gathered using validated self-administered questionnaire. The response rate was 87%. Half the 294 subjects who participated had a low knowledge, 33.0% a moderate knowledge and 17.0% a good knowledge about the EC pill. Eighty-eight percent of respondents had a positive attitude and 12.0% a negative attitude toward EC. Eleven percent of respondents had previously used EC. Unplanned and unwanted pregnancies were reported by 35.0% and 14.0% of respondents, respectively. Most respondents lacked knowledge about the indications for using EC, its mechanism of action, when it can be used and its side effects. Our findings show a need to educate women about EC.

Interactions of boron nitride nanosheet with amino acids of differential polarity.

Free amino acids represent a category of different biomolecules in the blood plasma, which bond together to make up larger organic molecules such as peptides and proteins. Their interactions with biocompatible nanoparticles are especially important for plasma-related biomedical applications. Among the various nanomaterials, the applications of carbon and boron nitride-based nanotubes/nanosheets have shown a huge increase in recent years. The effect of molecular polarity on the interaction between a boron nitride nanosheet (BNNS) and amino acids is investigated with quantum mechanical calculations by density functional theory (DFT), classical MD simulations, and well-tempered metadynamics simulations. Four representative amino acids, namely, alanine (Ala), a nonpolar amino acid, and aspartic acid (Asp), lysine (Lys) and serine (Ser), three polar amino acids are considered for their interactions with BNNS. In DFT calculations, the values of the adsorption energies for Lys-BNNS and Ser-BNNS complexes are - 48.32 and - 32.89 kJ/mol, respectively, which are more stable than the other cases. Besides, the adsorption energy calculated confirms the exergonic reactions for all investigated systems; it implied that the interaction is favorable electronically. The MD results show that the LYS molecules have a higher attraction toward BNNS because of its alkane tail in its side chain, and the ASP revealed the repulsion force originating from its COO- group. All the results are confirmed by free energy analyzes in which the LYS showed the highest adsorption free energy at a relatively farther distance than other complexes. In fact, our results revealed the contribution of functional groups and backbone of the amino acids in the adsorption or repulsion features of the studied systems.

Anti-oxidative and anti-hyperglycemic properties of Agastache foeniculum essential oil and oily fraction in hyperglycemia-stimulated and lipopolysaccharide-stimulated macrophage cells: In vitro and in silico studies.

ETHNOPHARMACOLOGICAL RELEVANCE: Hyperglycemia (HG) and lipopolysaccharide (LPS) often promote superoxide accumulation, which may increase oxidative stress. Reducing superoxide production in hyperglycemia and the inflammatory condition is an emerging way to reduce protein and lipid oxidation and diabetes complication. AIM OF STUDY: To examine the effect of Agastache foeniculum essential oil (AFEO) and oil fraction (AFoil) on HG- and LPS-stimulated oxidative stress, the pathogenicity of AFEO and AFoil on oxidative stress was assessed. METHODS: The stimulatory effects of AFEO and AFoil on the activity and expression of NADH oxide (NOX), catalase (CAT), superoxide dismutase (SOD), and the expression of nuclear respiratory factor 2 (NRF2) and nuclear factor-kappa B (NF-kB) in the stimulated macrophage cell line, J774.A1, was studied. The interaction patterns of AFEO and AFoil components with NOX, SOD, CAT, NRF2, and NF-kB proteins were also deduced using molecular docking. RESULTS: Estragole was the main ingredient in AFEO (97%). Linolenic acid (32.10%), estragole (16.22%), palmitic acid (12.62%), linoleic acid (12.04%), and oleic acid (8.73%) were the major chemical components of the AFoil. NOX activation was stimulated in macrophage cells by HG and LPS. At 20 µg/mL, AFEO and AFoil decreased NOX activity while increased SOD and CAT activities in stimulated macrophages. AFoil with estragole and omega-3 fatty acids was better than AFEO with estragole in anti-hyperglycemic and anti-oxidative activity. According to molecular docking research, estragole, linoleic acid, and linolenic acid bind to different hydrophobic pockets of NOX, SOD, CAT, NFR2, and NF-kB using hydrogen bonds, van der Waals bonds, pi-alkyl, and pi-anion interactions, with different binding energies. CONCLUSION: AFEO and AFoil showed antioxidant and anti-diabetic activity. The mechanisms in lowering oxidative stress markers depended on down-regulating superoxide-producing enzymes and up-regulating superoxide-removing enzymes at gene and protein levels. The AFoil emulsion can be used to reduce the detrimental impacts of hyperglycemia and oxidative stress.

Overcoming fear of movement resulting from knee replacement; strategies used by patients: An interview study.

BACKGROUND AND AIMS: Fear of movement is among the main concerns of patients following knee replacement surgery and a determining factor in the success of surgery. The strategies adopted by patients to overcome this fear have not yet been identified, but once pin pointed, these strategies can be strengthened and modified through intervention. The aim of the present study was to explore the personal strategies adopted by patients following knee replacement to overcome fear of movement. MATERIALS AND METHODS: Interviews were conducted with 15 patients who had undergone knee replacement, selected by purposive sampling. Data were collected through in-depth semi-structured interviews and analyzed using inductive content analysis. RESULTS: The patients' strategies as depicted in their narratives were classified into three categories: 1) Movement based on awareness; 2) Movement based on support; and 3) Movement based on hope. These three categories are described in eight subcategories and show what strategies the patients used to overcome their fear of movement. CONCLUSION: These findings can help to increase awareness about strategies to overcome fear of movement in patients following knee replacement and to develop and support tailored treatment strategies with the aim of reducing such fear of movement and increasing physical activity among the patients.

The contributing factors of resistance or sensitivity to epigenetic drugs in the treatment of AML.

Drug resistance is the drug-effectiveness reduction in treatment and is a serious problem in oncology and infections. In oncology, drug resistance is a complicated process resulting from enhancing the function of a pump that transports drugs out of tumor cells, or acquiring mutations in drug target. Surprisingly, most drugs are very effective in the early stages, but the response to the drug wears off over time and resistance eventually develops. Drug resistance is caused by genetic and epigenetic changes that affect cancer cells and the tumor environment. The study of inherited changes in the phenotype without changes in the DNA sequence is called epigenetics. Because of reversible changes in epigenetics, they are an attractive target for therapy. Some of these epigenetic drugs are effective in treating cancers like acute myeloid leukemia (AML), which is characterized by the accumulation and proliferation of immature hematopoietic cells in the blood and bone marrow. In this article, we outlined the various contributing factors involved in resistance or sensitivity to epigenetic drugs in the treatment of AML.

The role of miRNA-424 and miR-631 in various cancers: Focusing on drug resistance and sensitivity.

BACKGROUND: However, advanced technologies have been developed in the treatment of various cancers, but the mortality rate from cancer is still very high. Drug resistance is a major problem for patients with cancer, which causes the treatment process to fail. In addition to inhibiting drug resistance, targeted therapy is also very important in treatment. MAIN BODY: Nowadays, miRNAs have gained increasing interest as they play a major role in both drug resistance and targeted therapy. MicroRNA (miRNA) is an important part of non-coding RNA that regulates gene expression at a post-transcriptional level. The prevailing studies about miRNA expression have been expanded into a variety of neoplasms. MiR-424 and miR-631 targets genes involved in various cellular processes and can participate in proliferation, differentiation, apoptosis, invasion, angiogenesis, and drug resistance and sensitivity. CONCLUSION: In this study, we focus on the role of miR-424 and miR-631 in many cancer types by displaying the potential target genes associated with each cancer, as well as briefly describing the clinical uses of miR-424 and miR-631 as a diagnostic and predictive tool in malignancies.

Cell cycle involvement in cancer therapy; WEE1 kinase, a potential target as therapeutic strategy.

Mitosis is the process of cell division and is regulated by checkpoints in the cell cycle. G1-S, S, and G2-M are the three main checkpoints that prevent initiation of the next phase of the cell cycle phase until previous phase has completed. DNA damage leads to activation of the G2-M checkpoint, which can trigger a downstream DNA damage response (DDR) pathway to induce cell cycle arrest while the damage is repaired. If the DNA damage cannot be repaired, the replication stress response (RSR) pathway finally leads to cell death by apoptosis, in this case called mitotic catastrophe. Many cancer treatments (chemotherapy and radiotherapy) cause DNA damages based on SSBs (single strand breaks) or DSBs (double strand breaks), which cause cell death through mitotic catastrophe. However, damaged cells can activate WEE1 kinase (as a part of the DDR and RSR pathways), which prevents apoptosis and cell death by inducing cell cycle arrest at G2 phase. Therefore, inhibition of WEE1 kinase could sensitize cancer cells to chemotherapeutic drugs. This review focuses on the role of WEE1 kinase (as a biological macromolecule which has a molecular mass of 96 kDa) in the cell cycle, and its interactions with other regulatory pathways. In addition, we discuss the potential of WEE1 inhibition as a new therapeutic approach in the treatment of various cancers, such as melanoma, breast cancer, pancreatic cancer, cervical cancer, etc.

Clarifying the concept of the four-season symphony (I SEA) in nursing practice: A Wilson's approach to concept analysis.

Acquired knowledge provides one with intuitive rationality as a means of achieving a goal. Spiritual, ethical and esthetic competencies are also required for acquiring intuitive rationality. Nurses pay less attention to intuitive rationality, think only with their brain rather than observe with their heart and therefore deprive themselves of proper, immediate and comprehensive cognition of their environment. An initiative to harmonize sensory receptors in charge of thinking, speaking, and acting in nurses is required for establishing a symphonic intellectual, spiritual, ethical, and aesthetic (I SEA) nursing practice. The present research was conducted to clarify the concept of four-season symphony of I SEA in nursing practice. The present study was conducted by employing Wilson's method of concept analysis and searching databases including Google Scholar, ScienceDirect, Scopus, PubMed, SID, and Magiran using symphony, rationality, intellectuality, spirituality, ethics, aesthetic, and nursing practice as keywords. According to the integrated concept of the four-season symphony in nursing care, nursing practice refers to performing the symphonic action of four seasons of I SEA in orderly and smart thinking, speaking and acting in looking, listening, speaking, heartfelt sympathy and using the hands for caregiving and steps for accompanying patients. This symphony provides an opportunity for the emergence of perfect nurses of four seasons and helps with individual and organizational symphonic improvements in nursing care and nurses. According to this perspective, nurses should always ask themselves whether their thought, speech, and action are intellectual, spiritual, ethical and aesthetic.

Exploring the Lived Experience of Missed Nursing Care in Postgraduate Nursing Students in Iran.

BACKGROUND: Missed care is a global phenomenon, which can include many clinical conditions that threaten the patients' safety in all countries and cultures, and also indicates the quality of nursing care. The nursing students' awareness and understanding of missed nursing care is of great importance. The current study aims to explore the lived experience of postgraduate nursing students in missed care. METHODS: The current qualitative study was performed based on the interpretive phenomenological approach in Tehran, Iran, in February to December 2019. A total of 10 master's degree nursing students were selected through purposive sampling. A total of 10 semi-structured individual interviews were used to collect the data. The trail version of MAXQDA-10 software was used for coding. All interviews were recorded and codified, and the main themes were extracted from them using Dicklemann et al.'s (1989) analytical method. RESULTS: Two main themes, five sub-themes, and 31 meaning units were obtained. The main themes included: "unfulfilled care" and "living in limbo". CONCLUSION: Missed care, as unfulfilled care, is accompanied with living in limbo for nursing students, and this condition is influenced by organizational and personal factors. It seems that managers can prevent missed nursing care by supervising nursing care, reducing the nurses' workload, creating a sense of commitment to work, and enforcing ethical issues among nurses.

Psychometric properties of the Persian version of the quality of recovery-15 questionnaire.

BACKGROUND: Recovery after surgery is a complex process since it depends on many factors, such as the patient's sex, age, surgery type, and presence of other diseases. This study aimed to translate and evaluate the psychometric properties of the Persian version of the quality of recovery-15 (QoR-15) questionnaire in Iranian patients undergoing surgery. METHODS: The Persian version of the QoR-15 questionnaire was developed after translating and culturally validating the instrument. Content validity was assessed with a sample of clinicians (n = 15) and face validity was assessed in a sample of patients (n = 15) undergoing elective surgery. The final questionnaire was completed by 450 patients (n = 450) 24 h after surgery. Construct validity was assessed using exploratory factor analysis in patients (N = 250). Convergence and divergent validity were also assessed. Internal consistency was assessed using Cronbach's alpha and construct reliability was also assessed. Test-retest reliability was assessed on a randomly selected sub sample of 50 patients. Finally, the questionnaire was completed by a further sample of 200 patients 24 h after surgery and construct validity was assessed using confirmatory factor analysis. RESULTS: According to Lawshe, all items received at least an acceptable ratio for content validity ratio (CVR). Item content validity index (I-CVI) of each item was greater than 0.79. Construct validity indicated good fit statistics in the five components of CFA, and CFI was > 0.93. The reliability of the QoR-15 questionnaire was acceptable based on Cronbach's alpha score (> 0.001), test-retest reliability value (0.81), and CR (> 0.7). CONCLUSION: The Persian version of the QoR-15 questionnaire was equivalent to the original one regarding both conceptual and linguistic aspects. This study also confirmed the validity and reliability of the Persian version of the QoR-15 questionnaire. Therefore, the Persian version of the QoR-15 questionnaire can be a suitable and brief instrument to assess the recovery quality in Iranian patients undergoing surgery.

An Evaluation of Acupressure on the Sanyinjiao (SP6) and Hugo (LI4) Points on the Pain Severity and Length of Labor: A Systematic Review and Meta-analysis Study.

BACKGROUND: In this study, the effects of SP6 and LI4 acupressure on the pain severity and length of labor are examined. MATERIALS AND METHODS: This systematic review and meta-analysis study was performed on articles published in 2004-2015. The articles, published in the English and Farsi languages, related to the effects of acupressure on the SP6 and LI4 points on the length and pain severity of labor. Data were collected by searching medical databases, including PubMed, ISI, MagIran, Google Scholar, Iran Medex, SID, Irandoc, and EMBASE, for relevant material. RESULTS: Women who received SP6 acupressure experienced less pain immediately after the intervention [-0.56, 95% confidence interval (CI): -0.77, -0.36] than women in the touch group and exhibited decrease in the length of labor (-0.99, 95% CI: -1.39, -0.39), the active phase (0.95, 95% CI: -1.30, -0.61), and the second stage of labor (-0.39, 95% CI: -0.74, -0.03). Women who received LI4 acupressure experienced less pain immediately after the intervention (-0.94, 95%, CI: -1.36, -0.53) than women in the touch group and exhibited shorter active phase (-0.91, 95%, CI: -1.18, -0.63) and second stage of labor (-0.55, 95%, CI: -0.95, -0.15) lengths. CONCLUSIONS: The use of SP6 and LI4 acupressure shows promise as a method for managing the length and pain severity of labor, but further study is required to establish its effectiveness along with other pharmacological and nonpharmacological methods.

The Effect of Sevoflurane Plus Propofol on Pain and Complications after Laminectomy: A Randomized Double Blind Clinical Trial.

INTRODUCTION: Pain is one of the most important reasons for the patients concern after surgery. The perfect sedative should have properties like rapid onset, least pain and adverse effects. AIM: To assess the effect of sevoflurane plus propofol on postoperative pain, haemodynamic stability and complication after lumbar disc surgery. MATERIALS AND METHODS: This was a randomized double- blind clinical trial. A total of 75 patients scheduled for elective lumbar disc surgery with simple random sampling design received sevoflurane (n=25, induced with Thiopentone and maintained with sevoflurane), propofol (n=25, induced and maintained with propofol) and sevoflurane plus propofol (n=25, induced with propofol and maintained with sevoflurane). Visual Analog Scale (VAS) was used to determine the intensity of postoperative pain. Complications after surgery and haemodynamic changes during surgery were recorded. RESULTS: The mean pain intensity and morphine consumption in the sevoflurane plus propofol group was lower compared to the propofol and sevoflurane groups at different intervals (p<0.001). The prevalence of shivering, nausea and vomiting in the sevoflurane plus propofol group was 24%, 28%, 28% respectively vs sevoflurane group 32%, 60%, 48% respectively and propofol group 32%, 16%, 12% respectively with p-value > 0.05, <0.001, <0.05 respectively. The mean blood pressure and heart rate were significantly lower in the sevoflurane plus propofol group compared to the propofol and sevoflurane groups (p<0.001). CONCLUSION: According to the effect on pain and complications after lumbar disc surgery sevoflurane plus propofol can be regarded as safe and alternative drug in general anaesthesia for these patients.

Comparing Gabapentin and Celecoxib in Pain Management and Complications After Laminectomy: A Randomized Double-Blind Clinical Trial.

BACKGROUND: Complications and postoperative pain are major care problems that can affect the quality of health care plan. OBJECTIVES: According to the use of multimodal therapy the current study aimed to compare the efficacy of gabapentin and celecoxib in pain management and complications after laminectomy at Ilam University of Medical Sciences, Ilam, Iran, in 2015. PATIENTS AND METHODS: In this randomized double-blind clinical trial, 114 patients scheduled for elective laminectomy with simple random sampling design received gabapentin (n = 38, 900 mg/day), celecoxib (n = 38, 600 mg/day) and placebo (n = 38, capsule contain starch). Visual analog scale (VAS) was used to determine the intensity of pain. Complications after surgery, anxiety scores before surgery and patient's satisfaction 24 hours after the surgery were recorded. RESULTS: The mean pain intensity in the gabapentin group was lower compared to those of the placebo and celecoxib groups respectively at different time durations (P < 0.001). The means of morphine consumption were 11.9 mg, 22.8 mg and 30.1 mg in the gabapentin, celecoxib and placebo groups, respectively (P < 0.001). The prevalence of shivering, nausea, vomiting and pruritus were 10.5%, 12.8%, 10.3% and 18.4% in the gabapentin group vs 31.5%, 29.8%, 32.4% and 28.9% in the celecoxib group and 42.1%, 44.7%, 39.5% and 44.7% in the placebo group (P < 0.001). The mean anxiety score in the gabapentin group was 2.4 vs those of the celecoxib group 3 and placebo group 3.6 (P < 0.001). The frequencies of drowsiness were 42.1%, 13.2% and 5.3% in the gabapentin, celecoxib and placebo groups, respectively (P < 0.001). In the gabapentin group, patient satisfaction was significantly higher compared to those of the placebo and celecoxib groups (P < 0.05). CONCLUSIONS: According to the effect of gabapentin on pain management, complications after laminectomy and increased patients satisfaction, it can be regarded as an alter native in multimodal analgesia.