Aerosol generation with the use of positive pressure ventilation via supraglottic airway devices: an observational study.

The amount of aerosol generation associated with the use of positive pressure ventilation via a supraglottic airway device has not been quantified. We conducted a two-group, two-centre, prospective cohort study in which we recruited 21 low-risk adult patients scheduled for elective surgery under general anaesthesia with second-generation supraglottic airway devices. An optical particle sizer and an isokinetic sampling probe were used to record particle concentrations per second at different size distributions (0.3-10 µm) during use as well as baseline levels during two common activities (conversation and coughing). There was a median (IQR [range]) peak increase of 2.8 (1.5-4.5 [1-28.1]) and 4.1 (2.0-7.1 [1-18.2]) times background concentrations during SAD insertion and removal. Most of the particles generated during supraglottic airway insertion (85.0%) and removal (85.3%) were < 3 µm diameter. Median (IQR [range]) aerosol concentration generated by insertion (1.1 (0.6-5.1 [0.2-22.3]) particles.cm-3 ) and removal (2.1 (0.5-3.0 [0.1-18.9]) particles.cm-3 ) of SADs were significantly lower than those produced during continuous talking (44.5 (28.3-70.5 [2.0-134.5]) particles.cm-3 ) and coughing (141.0 (98.3-202.8 [4.0-296.5]) particles.cm-3 ) (p < 0.001). The aerosol levels produced were similar with the two devices. The proportion of easily inhaled and small particles (<1 µm) produced during insertion (57.5%) and removal (57.5%) was much lower than during talking (99.1%) and coughing (99.6%). These results suggest that the use of supraglottic airway devices in low-risk patients, even with positive pressure ventilation, generates fewer aerosols than speaking and coughing in awake patients.

The complete chloroplast genome of Senna alata (L.) Roxb., an important medicinal plant from the Philippines.

Senna alata, a flowering shrub, is widely cultivated in the Philippines for its anti-fungal properties. Despite this, its chloroplast genome is not yet established. We assembled and annotated the complete chloroplast genome of accession from the germplasm collection of the Institute of Crop Science, University of the Philippines, Los Baños, using Illumina sequencing data. The complete cp genome was 159,176-bp long characterized by a large single copy of 88,769 bp, short single-copy of 18,301 bp and a pair of inverted repeat regions of 26,053 bp each. The overall GC content of the chloroplast genome was 36.4%. The plastome comprised 37 tRNA genes, 8 rRNA genes and 78 mRNA genes. Phylogenetic analysis showed that S. alata is closely related to S. siamea.

Alternatives to remifentanil for the analgesic component of total intravenous anaesthesia: a narrative review.

Propfol-remifentanil-based total intravenous anaesthesia has dominated recent clinical practice due to its favourable pharmacokinetic profile. Interruption in remifentanil supply has presented an opportunity to diversify or even avoid the use of opioids and consider adjuncts to propofol-based total intravenous anaesthesia. Propofol, while a potent hypnotic, is not an effective analgesic. The administration of opioids, along with other adjuncts such as α-2 adrenoceptor agonists, magnesium, lidocaine, ketamine and nitrous oxide provide surgical anaesthesia and avoids large doses of propofol being required. We provide an overview of both target-control and manual infusion regimes for the alternative opioids: alfentanil, sufentanil and fentanyl. The optimal combination of hypnotic-opioid dose, titration sequence and anticipated additional postoperative analgesia required depend on the chosen combination. In addition, we include a brief discussion on the role of non-opioid adjuncts in total intravenous anaesthesia, suggested doses and expected reduction in propofol dose.

Eligibility criteria for Menopausal Hormone Therapy (MHT): a position statement from a consortium of scientific societies for the use of MHT in women with medical conditions. MHT Eligibility Criteria Group.

This project aims to develop eligibility criteria for menopausal hormone therapy (MHT). The tool should be similar to those already established for contraception A consortium of scientific societies coordinated by the Spanish Menopause Society met to formulate recommendations for the use of MHT by women with medical conditions based on the best available evidence. The project was developed in two phases. As a first step, we conducted 14 systematic reviews and 32 metanalyses on the safety of MHT (in nine areas: age, time of menopause onset, treatment duration, women with thrombotic risk, women with a personal history of cardiovascular disease, women with metabolic syndrome, women with gastrointestinal diseases, survivors of breast cancer or of other cancers, and women who smoke) and on the most relevant pharmacological interactions with MHT. These systematic reviews and metanalyses helped inform a structured process in which a panel of experts defined the eligibility criteria according to a specific framework, which facilitated the discussion and development process. To unify the proposal, the following eligibility criteria have been defined in accordance with the WHO international nomenclature for the different alternatives for MHT (category 1, no restriction on the use of MHT; category 2, the benefits outweigh the risks; category 3, the risks generally outweigh the benefits; category 4, MHT should not be used). Quality was classified as high, moderate, low or very low, based on several factors (including risk of bias, inaccuracy, inconsistency, lack of directionality and publication bias). When no direct evidence was identified, but plausibility, clinical experience or indirect evidence were available, "Expert opinion" was categorized. For the first time, a set of eligibility criteria, based on clinical evidence and developed according to the most rigorous methodological tools, has been defined. This will provide health professionals with a powerful decision-making tool that can be used to manage menopausal symptoms.

The complete chloroplast genome of Vitex trifolia L. (Lamiaceae).

The three-leaved chaste tree (Vitex trifolia) is a medicinal and ornamental plant widely distributed from East Africa to the Pacific but has no complete chloroplast genome sequence. We assembled and characterized the V. trifolia accession from the germplasm collection of the Institute of Crop Science, University of the Philippines Los Baños. The complete plastome sequence is 154,444-bp long with 131 coding genes comprising 87 mRNA genes, 36 tRNA genes, and 8 rRNA genes. A phylogenetic analysis of the assembled genome, together with nine other Lamiaceae species, identified V. rotundifolia as its closest relative with available complete cpDNA sequence. The clustering also supports the genotypic similarity of the species belonging to trifolia group of the genus Vitex.

Pharmacological and clinical implications of local anaesthetic mixtures: a narrative review.

Various techniques have been explored to prolong the duration and improve the efficacy of local anaesthetic nerve blocks. Some of these involve mixing local anaesthetics or adding adjuncts. We did a literature review of studies published between 01 May 2011 and 01 May 2021 that studied specific combinations of local anaesthetics and adjuncts. The rationale behind mixing long- and short-acting local anaesthetics to hasten onset and extend duration is flawed on pharmacokinetic principles. Most local anaesthetic adjuncts are not licensed for use in this manner and the consequences of untested admixtures and adjuncts range from making the solution ineffective to potential harm. Pharmaceutical compatibility needs to be established before administration. The compatibility of drugs from the same class cannot be inferred and each admixture requires individual review. Precipitation on mixing (steroids, non-steroidal anti-inflammatory drugs) and subsequent embolisation can lead to serious adverse events, although these are rare. The additive itself or its preservative can have neurotoxic (adrenaline, midazolam) and/or chondrotoxic properties (non-steroidal anti-inflammatory drugs). The prolongation of block may occur at the expense of motor block quality (ketamine) or block onset (magnesium). Adverse effects for some adjuncts appear to be dose-dependent and recommendations concerning optimal dosing are lacking. An important confounding factor is whether studies used systemic administration of the adjunct as a control to accurately identify an additional benefit of perineural administration. The challenge of how best to prolong block duration while minimising adverse events remains a topic of interest with further research required.

Trabajos con menciones especiales de las 15 Jornadas Científicas y de Gestión del Hospital de Alta Complejidad en Red El Cruce Dr. Néstor C. Kirchner / Works with special mentions from the 15 Scientific and Management Conferences of the High Complexity Hospital in Red El Cruce Dr. Néstor C. Kirchner

El presente número reúne los trabajos con menciones especiales de las 15o Jornadas Científicas y de Gestión del Hospital de Alta Complejidad en Red El Cruce Dr. Néstor C. Kirchner realizadas durante los días 19, 20 y 21 de Octubre del 2022. La totalidad de trabajos se evaluaron por dos o más revisores, asignándole un puntaje que generó un ranking en su valoración que los postuló para presentación oral o póster. Durante la presentación se volvieron a evaluar y se seleccionaron tres trabajos de cada eje (Traslacional; Gestión; Salud. Territorio y redes; y asistencial) y tres pósters, que se describen a continuación.

This issue brings together the works with special mentions from the 15th Scientific and Management Conference of the High Complexity Hospital in Red El Cruce Dr. Néstor C. Kirchner held on October 19, 20 and 21, 2022. All works were evaluated by two or more reviewers, assigning a score that generated a ranking in their assessment that nominated them for oral or poster presentation. During the presentation, three works from each axis (Translational; Management; Health. Territory and networks; and healthcare) and three posters were re-evaluated and selected, which are described below.

Evaluation of Deep Learning Methods in a Dual Prediction Scheme to Reduce Transmission Data in a WSN.

One of the most important challenges in Wireless Sensor Networks (WSN) is the extension of the sensors lifetime, which are battery-powered devices, through a reduction in energy consumption. Using data prediction to decrease the amount of transmitted data is one of the approaches to solve this problem. This paper provides a comparison of deep learning methods in a dual prediction scheme to reduce transmission. The structures of the models are presented along with their parameters. A comparison of the models is provided using different performance metrics, together with the percent of points transmitted per threshold, and the errors between the final data received by Base Station (BS) and the measured values. The results show that the model with better performance in the dataset was the model with Attention, saving a considerable amount of data in transmission and still maintaining a good representation of the measured data.

Trabajos con mención de las 14º Jornadas Científicas y de Gestión del Hospital de Alta Complejidad en Red El Cruce Dr. Néstor C. Kirchner, 3, 4 y 5 de noviembre del 2021. Florencio Varela, Buenos Aires, Argentina. / Papers with mention of the 14th Scientific and Management Conference of the Hospital de Alta Complexidad en Red El Cruce Dr. Néstor C. Kirchner, November 3, 4 and 5, 2021. Florencio Varela, Buenos Aires, Argentina

El presente número reúne los trabajos con mención de las 14º Jornadas Científicas y de Gestión del Hospital de Alta Complejidad en Red El Cruce Dr. Néstor C. Kirchner, 3, 4 y 5 de noviembre del 2021. Florencio Varela, Buenos Aires, Argentina.

Neuroleptic Malignant Syndrome Secondary to Quetiapine in Critical Care: A Case Report.

Quetiapine, an atypical antipsychotic, is widely used to treat delirium in intensive care units (ICUs). Studies demonstrate its efficacy and favorable safety profile. We report a case of an elderly patient who developed clinical and biochemical evidence of neuroleptic malignant syndrome (NMS) 5 days after quetiapine was commenced. Signs of NMS resolved after discontinuation of quetiapine and administration of dantrolene. Quetiapine-induced NMS has occurred with long-term use in the elderly in the outpatient setting. However, NMS has not previously been reported after treatment of ICU delirium. NMS is an important complication to consider before prescribing quetiapine in the ICU.

Use of commercial pharmaceutical drug (Daktarin®) for retrospective/accidental/forensic thermoluminescence dosimetry.

Retrospective/accidental dosimetry seeks for materials that can be used as probes for the dose assessment by means of several methods when there is no dose data available (e.g. from personal dosimeters). In the same respect, researchers also seek materials appropriate for forensic purposes, which would allow to identify the prior presence of radioactive materials at buildings, sites or even vehicles. To this direction, several solid-state drugs, which are ubiquitous, have also been studied as probes for the dose estimation in emergency situations. However, due to their heat-sensitive character, measurements were possible only with OSL. The scope of the present work is to identify a heat-resistant drug (Daktarin) and conduct, for the first time, a detailed study of the thermoluminescence properties of it along with computerized curve deconvolution analysis which would shed light on the traps involved. Results indicate that the glow curve of Daktarin has at least three peaks that can be used for dosimetric purposes, since they exhibit linear dose response for doses up to 20 Gy, do not exhibit any sensitization, have high lifetime and their stability with time is good, since an appreciable signal remains unaffected even 3 months post irradiation. All the above were validated conducting dose recovery tests and successfully calculating the unknown delivered dose for various periods after the irradiation of the samples. The new findings are very supportive and point towards the efficient use of commercial pharmaceuticals as probes for retrospective/accidental/forensic dosimetry using thermoluminescence.