Single intravenous dose ondansetron induces QT prolongation in adult emergency department patients: a prospective observational study.

BACKGROUND: Ondansetron is one of the most commonly used drugs in the emergency department (ED) for treating nausea and vomiting, particularly in intravenous (IV) form. Nevertheless, it has been shown to prolong QT interval and increase the risk of ventricular dysrhythmias. This study evaluated the associations between single IV ondansetron dosage and subsequent QTc prolongation in the ED. METHODS: In this prospective observational study, a total number of 106 patients presenting to the ED in a 3-month period with nausea and vomiting treated with IV ondansetron were enrolled. QT and QTc intervals were measured at baseline (QT0 and QTc0), and 60 min (QT60 and QTc60) following a single-dose administration of ondansetron at 4 or 8 mg doses. To evaluate the predictive ability of these variables, we employed receiver operating characteristic (ROC) curve analyses. RESULTS: The predictive models for QTc prolongation 1-hour post-ondansetron administration showed the following: at baseline, the area under curve of 0.70 for QT, 0.71 for QTc, and 0.64 for dosage. Conversely, a QTc0 = 375 msec indicated a QTc60 > 480 msec with a specificity of 97%. Additionally, a QTc0 of 400 msec had a sensitivity of 100% in predicting a QTc60 < 480 msec, while a QTc0 > 460 msec predicted a QTc60 > 480 msec with a specificity of 98%. Moreover, 8 mg doses were associated with higher rates of QTc60 prolongation, while 4 mg doses favored maintaining QTc60 within normal limits. CONCLUSIONS: Our study demonstrates the predictive capacity of QT0, QTc0, and ondansetron dosage in forecasting QTc60 prolongation (> 480 msec) post-ondansetron administration. These findings advocate for their incorporation into clinical protocols to enhance safety monitoring in adult ED patients.

Promoter Methylation of Two HOXA9 and NISCH Genes in Opium Users.

Background: Opiate abuse has been critically increased in the world, especially in Iran. Owing to the association of opiate use with multiple human cancers and neurological disorders, seeking for genetic and epigenetic effects of opium can pave the way for early diagnosis of major health defects in addicted users. Accordingly, the present study aimed to determine the methylation status of the promoter of two genes, which are actively involved in neurodevelopment and cancer evolution. Methods: DNA was isolated from peripheral blood of 28 opium abusers and 19 healthy controls and then subjected to sonication. Sonicated DNAs undergone methylated DNA immunoprecipitation-real time polymerase chain reaction (MeDIP-Real Time PCR) using specific primer pairs designed for HOXA9 and NISCH genes. Obtained data were analyzed using SPSS software. Findings: HOXA9 and NISCH genes were found to be significantly methylated in addicted users compared to controls (P<0.001) which was significantly associated with the mean of the age regarding HOXA9 gene (P=0.002). Neither opium amount nor duration or route of using was associated with the methylation status of HOXA9 or NISCH genes. Conclusion: Hypermethylation of HOXA9 and NISCH genes as tumor suppressor in opium-addicted individuals can be considered as confirmatory evidence for carcinogenesis of opium. Further studies are required to figure out the role of epigenetic alterations in cancer evolution among opium users.

Global Trend on Machine Learning in Helicobacter within One Decade: A Scientometric Study.

Purpose: This study aims to create a science map, provide structural analysis, investigate evolution, and identify new trends in Helicobacter pylori (H. pylori) research articles. Methods: All Helicobacter publications were gathered from the Web of Science (WoS) database from August 2010 to 2021. The data were required for bibliometric analysis. The bibliometric analysis was performed with Bibliometrix R Tool. Bibliometric data were analyzed using the Bibliometrix Biblioshiny R-package software. Results: A total of 17,413 articles were reviewed and analyzed, with descriptive characteristics of the H. pylori literature included. In journals, 21,102 keywords plus and 20,490 author keywords were reported. These articles were also written by 56,106 different authors, with 262 being single-author articles. Most authors' abstracts, titles, and keywords included "Helicobacter-pylori." Since 2010, the total number of H. pylori-related publications has been decreasing. Gut, PLOS ONE, and Gastroenterology are the most influential H. pylori journals, according to source impact. China, the United States, and Japan are the countries with most affiliations and subjects. In addition, Seoul National University has published the most articles about H. pylori. According to the cloud word plot, the authors' most frequently used keywords are gastric cancer (GC), H. pylori, gastritis, eradication, and inflammation. "Helicobacter pylori" and "infection" have the steepest slopes in terms of the upward trend of words used in articles from 2010 to 2021. Subjects such as GC, intestinal metaplasia, epidemiology, peptic ulcer, eradication, and clarithromycin are included in the diagram's motor theme section, according to strategic diagrams. According to the thematic evolution map, topics such as Helicobacter pylori infection, B-cell lymphoma, CagA, Helicobacter pylori, and infection were largely discussed between 2010 and 2015. From 2016 to 2021, the top topics covered included Helicobacter pylori, H. pylori infection, and infection.

Quinazoline-based VEGFR-2 inhibitors as potential anti-angiogenic agents: A contemporary perspective of SAR and molecular docking studies.

Angiogenesis, the formation of new blood vessels from the existing vasculature, is pivotal in the migration, growth, and differentiation of endothelial cells in normal physiological conditions. In various types of tumour microenvironments, dysregulated angiogenesis plays a crucial role in supplying oxygen and nutrients to cancerous cells, leading to tumour size growth. VEGFR-2 tyrosine kinase has been extensively studied as a critical regulator of angiogenesis; thus, inhibition of VEGFR-2 has been widely used for cancer treatments in recent years. Quinazoline nucleus is a privileged and versatile scaffold with a broad range of pharmacological activity, especially in the field of tyrosine kinase inhibitors with more than twenty small molecule inhibitors approved by the US Food and Drug Administration in the last two decades. As of now, the U.S. FDA has approved eleven small chemical inhibitors of VEGFR-2 for various types of malignancies, with a prime example being vandetanib, a quinazoline derivative, which is a multi targeted kinase inhibitor used for the treatment of late-stage medullary thyroid cancer. Despite of prosperous discovery and development of VEGFR-2 down regulator drugs, there still exists limitations in clinical efficacy, adverse effects, a high rate of clinical discontinuation and drug resistance. Therefore, there is an urgent need for the design and synthesis of more selective and effective inhibitors to tackle these challenges. Through the gathering of this review, we have strived to broaden the extent of our view over the entire scope of quinazoline-based VEGFR-2 inhibitors. Herein, we give an overview of the importance and advancement status of reported structures, highlighting the SAR, biological evaluations and their binding modes.

Emergency Severity Index Triage in Iran: A Comparison Between Age Groups in a Trauma Center.

There are concerns about the accuracy of Emergency Severity Index (ESI) triage system in the geriatric population. This study was performed to compare the correlation of ESI triage with injury severity score (ISS) between adults with trauma younger than 60 years and those 60 years of age and older and to determine the ability of ESI to predict an ISS of greater than 15 in these two age groups. This was an observational study performed in an academic trauma center in Kerman, Iran. A convenience sample of trauma patients older than 16 years was included. Five-level ESI triage was performed by nurses with 2-10 years of exclusive experience in triage. The ISS scores were calculated by the researchers. Both numerical and categorical (ISS >15) forms of the score were considered as outcomes. Ultimately, a total of 556 patients were enrolled in the study. No difference in undertriage was seen between the age groups (p = 0. 51). Spearman's correlation coefficient between ESI level and ISS was -0.69 and -0.77 in patients younger than 60 years and those aged 60 years or older, respectively (z = 1.20). The areas under the curves (AUCs) for prediction of ISS of greater than 15 were also similar between the two age groups (0.89 in less than 60 and 0.85 in 60 or more). In conclusion, the performance of ESI was similar between the two age groups. Therefore, the application of the ESI triage system for initial categorization of trauma patients seems to be a reliable and easy-to-learn method for the triage of elderly as well as younger age groups.

COMPARISON OF ULTRASOUND-GUIDED ERECTOR SPINAE PLANE BLOCK WITH INTERCOSTAL NERVE BLOCK FOR TRAUMA-ASSOCIATED CHEST WALL PAIN.

BACKGROUND: Pain associated with chest wall trauma is a major issue in the emergency department (ED). However, it may be challenging to select among the various analgesic procedures. OBJECTIVE: Our aim was to compare single-shot erector spinae plane block (ESPB) with intercostal nerve block (ICNB) under ultrasound guidance for pain management in thoracic trauma. METHODS: This study was a randomized nonblinded clinical trial performed in a level I urban trauma center. A convenience sample of patients with isolated chest wall trauma and initial Numeric Rating Scale pain scores (NRS 0) > 5 were included. Exclusion criteria were large pain area, surgical interventions, discharged from the ED, and presence of contraindications to lidocaine. Pain scores at 20 min and 60 min (NRS 20 and 60) and at disposition (disp) were recorded. RESULTS: Twenty-seven patients in the ESPB and 23 in the ICNB groups were enrolled. Mean values of NRS 0, 20, 60, and disp for the ESPB vs. ICNB groups were 8.0 vs. 7.4, 5.2 vs. 6.1, 4.1 vs. 5.4, and 4.3 vs. 5.8, respectively (p = 0.07, p = 0.04, p = 0.001, and p < 0.001, respectively). Four patients in the ESPB and 8 patients in the ICNB groups required administration of adjunctive doses of fentanyl for satisfactory pain control (p = 0.09). CONCLUSIONS: Ultrasound-guided ESPB was superior to ICNB regarding pain control during the ED stay period of patients with painful chest wall trauma. We recommend ESPB in the ED for pain control in blunt or penetrating thoracic trauma.

COVID-19 patients at referral to hospital during the first peak of disease: Common clinical findings including myalgia and fatigue.

The wide range of manifestations and clinical symptoms of COVID-19 has made it a unique disease. Investigating the epidemiology of different clinical manifestations of this disease in patients referred to medical centers is one of the most effective steps in adopting a suitable diagnostic and treatment approach. These findings also provide a basis for comparing the evolution of the virus and its clinical manifestations over time and at different peaks of the disease. Therefore, the present study was aimed at investigating common clinical findings at the time of referral in patients with COVID-19 in Afzalipour Hospital, Kerman, during the first peak of the disease. This descriptive-analytical cross-sectional study was performed on hospitalized patients diagnosed with COVID-19, between March 2020 and June 2020. The patients were included in the study by census method, and the research variables related to demographic indicators, disease course and clinical symptoms were extracted from the patients' medical records, and then subjected to statistical analysis. In this study, a total of 210 patients were examined, consisted mainly of male patients (59.5%). The mean age was found to be 53.95 ± 19.55 years. Also, 20.3% of patients needed admission in the intensive care unit. In addition, 1% of patients were infected in February 2020, 24% in March 2020, 47.4% in April 2020 and 27.4% in May 2020. The mean onset of symptoms until hospitalization was also found as 6.51 days. The most common clinical symptoms included shortness of breath (75.7%), dry cough (52.9%), fever (50.5%), myalgia (45.7%) and fatigue (41.9%). Fever at admission time was significantly more common in ages less than 50 years (p=0.034). Our study showed that the most common clinical symptoms were shortness of breath, dry cough, fever, myalgia and fatigue. No statistically significant difference was found in common symptoms between men and women. Among the common clinical symptoms, only fever at admission time was observed to be significantly higher in those under 50 years of age.

The effect of different genres of music and silence on relaxation and anxiety: A randomized controlled trial.

High stress and anxiety in healthy individuals may lead to use different pharmacological and non-pharmacological therapies. The study aimed to investigate the effect of different genres of music on anxiety and relaxation in healthy participants. This study was a randomized controlled trial with a cross-over design. Forty-six healthy undergraduates participated in the study and randomly received different genres of music (Pop, Rock, Western Classical, and Persian Traditional) and silence for five consecutive days between February and June 2018. Each participant was her/his own control. Relaxation and the State Anxiety were checked with Smith Relaxation States Inventory 3 and The State Anxiety Inventory before and after listening to 15 min of music or laying down in silence. None of the five procedures were preferred for a more relaxing effect (P > 0.05). Also, none of the interventions were preferred for reduction of the state anxiety (P > 0.05). Although different genres of music, i.e., Pop, Rock, Western Classical, Persian Traditional, could reduce state anxiety and improve relaxation, they had no extra effect compared to Silence.