Evaluación de la eficacia de la N-acetilcisteína y la bromhexina en comparación con la atención estándar en la prevención de la hospitalización de pacientes ambulatorios con COVID-19: un ensayo clínico aleatorizado doble ciego / Evaluation of the efficacy of N-acetylcysteine and bromhexine compared with standard care in preventing hospitalization of outpatients with COVID-19: a double blind randomized clinical trial

Introducción y objetivo Desde su aparición en diciembre de 2019, la enfermedad por coronavirus causada por el síndrome respiratorio agudo severo coronavirus2 se ha convertido en una emergencia mundial, propagándose rápidamente por todo el mundo. En respuesta a la derivación temprana de estos pacientes a centros de salud ambulatorios, decidimos buscar tratamientos más eficaces en las primeras etapas de su derivación. Este estudio tiene como objetivo prevenir tanto la progresión como el deterioro de las condiciones físicas de los pacientes con COVID-19, reducir la tasa de derivaciones y mitigar los riesgos de hospitalización y de muerte. Material y métodos Realizado en el Centro Terapéutico Dibaj, ciudad de Hamadan, Irán, un ensayo controlado aleatorizado doble ciego abarcó 225 pacientes con COVID-19 de abril a septiembre de 2022. Se obtuvo la aprobación ética de la Universidad de Ciencias Médicas de Hamadan (Aprobación n.° IR.UMSHA .REC.1400.957), con el protocolo registrado en el Registro Iraní de Ensayos Clínicos (Registro n.° IRCT20220302054167N1). Los pacientes cumplieron con el diagnóstico de COVID-19 a través de la presentación de síntomas y la confirmación por PCR, excluyendo aquellos con antecedentes de vacunas y afectación de órganos. Los pacientes con una saturación de oxígeno superior al 92% se asignaron a tres grupos: el grupoA recibió N-acetilcisteína, el grupoB recibió bromhexina y el grupoC recibió atención estándar. Los seguimientos de los niveles de oxígeno, los síntomas y las necesidades de hospitalización se realizaron los días7 y 14, con pacientes hospitalizados monitorizados durante un mes después de la hospitalización. Resultados El estudio encontró que tanto la N-acetilcisteína como la bromhexina pueden reducir efectivamente las tasas de hospitalización y la mortalidad y acortar la duración de la hospitalización... (AU)

Introduction and aim Since its emergence in December 2019, the coronavirus disease caused by the severe acute respiratory syndrome coronavirus2 has become a global emergency, spreading rapidly worldwide. In response to the early referral of these patients to outpatient health centers, we decided to seek more effective treatments in the early stages of their referral. This study aims to prevent both the progression and deterioration of the physical conditions of COVID-19 patients, reduce the rate of referrals, and mitigate the risks of hospitalization and death. Material and methods Conducted at Dibaj Therapeutic Center, Hamadan City, Iran, a double-blind randomized controlled trial encompassed 225 COVID-19 patients from April to September 2022. Ethical approval was obtained from Hamadan University of Medical Sciences (Approval No.: IR.UMSHA.REC.1400.957), with the protocol registered in the Iranian Registry of Clinical Trials (Registration No.: IRCT20220302054167N1). In this study, we included patients who tested positive for COVID-19 PCR and were symptomatic, excluding those who were pregnant or had received a COVID-19 vaccine. Patients with oxygen saturation above 92% were allocated to three groups: GroupA received N-acetylcysteine, GroupB received Bromhexine, and GroupC received standard care. Follow-ups on oxygen levels, symptoms, and hospitalization needs were conducted on days 7 and 14, with hospitalized patients monitored for one month post-hospitalization. Results The study found that both N-acetylcysteine and Bromhexine can effectively reduce hospitalization rates and mortality and shorten the duration of hospitalization. The third visit of patients who received N-acetylcysteine showed an increase of 1.33% in oxygen saturation compared to their first visit, and in patients who received Bromhexine, this increase was 1.19%. The mortality rate was 9.33% in the control group and zero in both groups of patients who received medication... (AU)

Evaluación de la eficacia de la N-acetilcisteína y la bromhexina en comparación con la atención estándar en la prevención de la hospitalización de pacientes ambulatorios con COVID-19: un ensayo clínico aleatorizado doble ciego / Evaluation of the efficacy of N-acetylcysteine and bromhexine compared with standard care in preventing hospitalization of outpatients with COVID-19: a double blind randomized clinical trial

Introducción y objetivo Desde su aparición en diciembre de 2019, la enfermedad por coronavirus causada por el síndrome respiratorio agudo severo coronavirus2 se ha convertido en una emergencia mundial, propagándose rápidamente por todo el mundo. En respuesta a la derivación temprana de estos pacientes a centros de salud ambulatorios, decidimos buscar tratamientos más eficaces en las primeras etapas de su derivación. Este estudio tiene como objetivo prevenir tanto la progresión como el deterioro de las condiciones físicas de los pacientes con COVID-19, reducir la tasa de derivaciones y mitigar los riesgos de hospitalización y de muerte. Material y métodos Realizado en el Centro Terapéutico Dibaj, ciudad de Hamadan, Irán, un ensayo controlado aleatorizado doble ciego abarcó 225 pacientes con COVID-19 de abril a septiembre de 2022. Se obtuvo la aprobación ética de la Universidad de Ciencias Médicas de Hamadan (Aprobación n.° IR.UMSHA .REC.1400.957), con el protocolo registrado en el Registro Iraní de Ensayos Clínicos (Registro n.° IRCT20220302054167N1). Los pacientes cumplieron con el diagnóstico de COVID-19 a través de la presentación de síntomas y la confirmación por PCR, excluyendo aquellos con antecedentes de vacunas y afectación de órganos. Los pacientes con una saturación de oxígeno superior al 92% se asignaron a tres grupos: el grupoA recibió N-acetilcisteína, el grupoB recibió bromhexina y el grupoC recibió atención estándar. Los seguimientos de los niveles de oxígeno, los síntomas y las necesidades de hospitalización se realizaron los días7 y 14, con pacientes hospitalizados monitorizados durante un mes después de la hospitalización. Resultados El estudio encontró que tanto la N-acetilcisteína como la bromhexina pueden reducir efectivamente las tasas de hospitalización y la mortalidad y acortar la duración de la hospitalización... (AU)

Introduction and aim Since its emergence in December 2019, the coronavirus disease caused by the severe acute respiratory syndrome coronavirus2 has become a global emergency, spreading rapidly worldwide. In response to the early referral of these patients to outpatient health centers, we decided to seek more effective treatments in the early stages of their referral. This study aims to prevent both the progression and deterioration of the physical conditions of COVID-19 patients, reduce the rate of referrals, and mitigate the risks of hospitalization and death. Material and methods Conducted at Dibaj Therapeutic Center, Hamadan City, Iran, a double-blind randomized controlled trial encompassed 225 COVID-19 patients from April to September 2022. Ethical approval was obtained from Hamadan University of Medical Sciences (Approval No.: IR.UMSHA.REC.1400.957), with the protocol registered in the Iranian Registry of Clinical Trials (Registration No.: IRCT20220302054167N1). In this study, we included patients who tested positive for COVID-19 PCR and were symptomatic, excluding those who were pregnant or had received a COVID-19 vaccine. Patients with oxygen saturation above 92% were allocated to three groups: GroupA received N-acetylcysteine, GroupB received Bromhexine, and GroupC received standard care. Follow-ups on oxygen levels, symptoms, and hospitalization needs were conducted on days 7 and 14, with hospitalized patients monitored for one month post-hospitalization. Results The study found that both N-acetylcysteine and Bromhexine can effectively reduce hospitalization rates and mortality and shorten the duration of hospitalization. The third visit of patients who received N-acetylcysteine showed an increase of 1.33% in oxygen saturation compared to their first visit, and in patients who received Bromhexine, this increase was 1.19%. The mortality rate was 9.33% in the control group and zero in both groups of patients who received medication... (AU)

Evaluation of the efficacy of N-acetylcysteine and bromhexine compared with standard care in preventing hospitalization of outpatients with COVID-19: a double blind randomized clinical trial.

INTRODUCTION AND AIM: Since its emergence in December 2019, the coronavirus disease caused by the severe acute respiratory syndrome coronavirus 2 has become a global emergency, spreading rapidly worldwide. In response to the early referral of these patients to outpatient health centers, we decided to seek more effective treatments in the early stages of their referral. This study aims to prevent both the progression and deterioration of the physical conditions of COVID-19 patients, reduce the rate of referrals, and mitigate the risks of hospitalization and death. MATERIAL AND METHODS: Conducted at Dibaj Therapeutic Center, Hamadan City, Iran, a double-blind randomized controlled trial encompassed 225 COVID-19 patients from April to September 2022. Ethical approval was obtained from Hamadan University of Medical Sciences (Approval No.: IR.UMSHA.REC.1400.957), with the protocol registered in the Iranian Registry of Clinical Trials (Registration No. : IRCT20220302054167N1). In this study, we included patients who tested positive for COVID-19- PCR and were symptomatic, excluding those who were pregnant or had received a COVID-19 vaccine. Patients with oxygen saturation above 92% were allocated to three groups: Group A received N-acetylcysteine, Group B received Bromhexine, and Group C received standard care. Follow-ups on oxygen levels, symptoms, and hospitalization needs were conducted on days 7 and 14, with hospitalized patients monitored for one month post-hospitalization. RESULTS: The study found that both N-acetylcysteine and Bromhexine can effectively reduce hospitalization rates and mortality and shorten the duration of hospitalization. The third visit of patients who received N-acetylcysteine showed an increase of 1.33% in oxygen saturation compared to their first visit, and in patients who received Bromhexine, this increase was 1.19%. The mortality rate was 9.33% in the control group and zero in both groups of patients who received medication. CONCLUSION: In conclusion, the results of this study indicate that NAC and bromhexine may be effective in the treatment of patients with positive COVID-19, with a lower hospitalization rate, shorter hospitalization, faster recovery time, and reduced mortality compared to the control group.

Relationship between Lifestyle and Frailty among Iranian Community-Dwelling Older Adults: Pilot Study.

Background: Aging affects physical, mental, and social functions, which can lead to an increase in frailty. Old adults with frailty syndrome are prone to disabilities and hospitalization. Lifestyle is a context-based factor that has the potential to prevent frailty. Objectives: This study aimed to assess the relationship between lifestyle and frailty among Iranian community-dwelling older adults. Design Setting: This is a descriptive-analytical cross-sectional study. The participants were 513 older adults over 60 years by the convenience sampling method from the retirement center. Measurements: Data were collected using Tilberg's frailty index, the Iranian elderly lifestyle questionnaire, and the Mini-Cog test. Data were analyzed with SPSS v.26 software by chi-square and logistic regression tests. Results: The age of the participants was 66.43 ± 4.69 years. The male-to-female sex ratio was 1.5 (39.2% women). The lifestyle of 96 (19.3%) old adults was unfavorable. 18.7 percent of older adults had Frailty syndrome. The logistic regression test showed that moderate and favorable lifestyle (OR= 0.06; 95% CI: 0.02-0.16), age over 75 years (OR= 5.25; 95% CI: 2.35-11.69), retired employment status (OR= 0.13; 95% CI: 0.29-0.05) are factors that have a significant relationship with frailty (P< 0.05). Conclusion: The findings showed that lifestyle can predict frailty. Therefore, it seems that an optimal lifestyle can prevent the frailty of older adults.

Cyclin-dependent kinase 6 (CDK6) as a potent regulator of the ovarian primordial-to-primary follicle transition.

Introduction: Ovarian follicle development requires tight coordination between several factors to initiate folliculogenesis to generate a mature and fertile egg. Studies have shown that cell cycle factors might contribute to follicle development, hover specific knowledge on individual CDKs and follicle activation has not been investigated. Among cell cycle regulators, CDK6 is a key player through binding to cyclin D resulting DNA synthesis and genome duplication. Interestingly, the CDK6 gene is differentially expressed in oocytes and granulosa cells from human primordial and primary follicles, which suggest a potential role of CDK6 in the primordial-to-primary transition. In this study, we investigated the potential regulatory role of CDK6 in progression of primordial to primary follicle transition using BSJ-03-123 (BSJ), a CDK6-specific degrader. Methods: In mouse ovarian in vitro culture, BSJ reduced the activation of primordial follicles, and reduced follicle development. As a next step, we examined the egg maturation read-out and found that BSJ-treated follicles matured to competent MII eggs with resumption of first meiosis, comparable with the control group. Results: Noteworthy, it appears that inhibition of CDK6 did increase number of apotoptic cells, articular in the granulosa cells, but had no impact on ROS level of cultured ovaries compared to control group, indicating that the cells were not stressed. Oocyte quality thus appeared safe. Discussion: The results of this study indicate that CDK6 plays a role in the primordial-to-primary transition, suggesting that cell cycle regulation is an essential part of ovarian follicle development.

Designing a Predictive Model for Colorectal Neoplasia Diagnosis Based on Clinical and Laboratory Findings in Colonoscopy Candidate Patients.

BACKGROUND: Health authorities have expanded two strategies to diminish CRC-related influence: CR screening and improve diagnostic process in symptomatic patients. The aim of the current study is to design a predictive model to identify the most important risk factors that can efficiently predict patients who have high risk of colorectal neoplasia. METHOD: A cross-sectional study was constructed to include all patients who had positive test for FIT or had one or more risk factors for colorectal cancer based on the guidelines of detecting high-risk groups for colorectal cancer in Iran. Multivariable binary logistic regression model was constructed for prediction of colorectal neoplasia. We used sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio to check the accuracy. The Hosmer-Lemeshow test, chi-square test, and p value were used to determine the precision of model. RESULT: Following an AIC stepwise selection model, only nine potential variables, namely gender, watery diarrhea, IBD, abdominal pain, melena, body mass index, depression drug, anti-inflammatory drug, and age, were found to be a predictor of colorectal neoplasia. The best cut-point probability in the final model was 0.27 and results of sensitivity and specificity, based on maximizing these two criteria, were 66% and 62%, respectively. CONCLUSION: Overall, our model prediction was comparable with other risk prediction models for colorectal cancer. It had a modest discriminatory power to distinguish an individual's neoplasia colorectal risk.

Machine learning algorithms to predict seizure due to acute tramadol poisoning.

INTRODUCTION: This study was designed to develop and evaluate machine learning algorithms for predicting seizure due to acute tramadol poisoning, identifying high-risk patients and facilitating appropriate clinical decision-making. METHODS: Several characteristics of acute tramadol poisoning cases were collected in the Emergency Department (ED) (2013-2019). After selecting important variables in random forest method, prediction models were developed using the Support Vector Machine (SVM), Naïve Bayes (NB), Artificial Neural Network (ANN) and K-Nearest Neighbor (K-NN) algorithms. Area Under the Curve (AUC) and other diagnostic criteria were used to assess performance of models. RESULTS: In 909 patients, 544 (59.8%) experienced seizures. The important predictors of seizure were sex, pulse rate, arterial blood oxygen pressure, blood bicarbonate level and pH. SVM (AUC = 0.68), NB (AUC = 0.71) and ANN (AUC = 0.70) models outperformed k-NN model (AUC = 0.58). NB model had a higher sensitivity and negative predictive value and k-NN model had higher specificity and positive predictive values than other models. CONCLUSION: A perfect prediction model may help improve clinicians' decision-making and clinical care at EDs in hospitals and medical settings. SVM, ANN and NB models had no significant differences in the performance and accuracy; however, validated logistic regression (LR) was the superior model for predicting seizure due to acute tramadol poisoning.

Prediction of Hospitalization Length. Quantile Regression Predicts Hospitalization Length and its Related Factors better than Available Methods.

BACKGROUND: Length of hospitalization is one of the most important indices in evaluating the efficiency and effectiveness of hospitals and the optimal use of resources. Identifying these indices' associated factors could be useful. This study aimed to investigate effective factors of the length of hospitalization in Zanjan teaching hospitals in 2018 using the Quantile regression model. METHODS: This cross-sectional study was conducted on 1,031 patients. The study population consisted of patients in orthopaedic, pediatric, internal, surgical and intensive care units. The samples were selected by multistage random sampling. The information was collected by a pre-designed checklist. The Quantile regression model and ordinary regression model were performed on the data. RESULTS: Of the 1,031 patients admitted to different units, 624 (60.52%) were male. Mean and standard deviation of length of hospitalization for men, women and all patients were 7.25±5.48, 8.09±6.35 and 7.58±5.83 respectively. For 90 percent of patients the length of hospitalization was less than 14 days. Twenty-five percent of patients in pediatric and orthopedic units and ten percent of patients in internal and surgery units were hospitalized less than three days. In all quantiles, patients' length of hospitalization in surgery and orthopedic units, compared to the intensive care unit, and patients hospitalized for injuries and poisonings compared to other causes, had a statistically significant difference. (p<0.05). CONCLUSION: Due to the heterogeneity (skewness) of the length of hospital stay in different units of the hospital, the quantile regression model predicts the length of hospital stay more precisely than the ordinary regression models.

Rate of the incidence of hospital-acquired infections in Iran based on the data of the national nosocomial infections surveillance.

Hospital-acquired infections (HAIs) lead to increased length of hospital stay, inappropriate use of broad-spectrum antibiotics and multiple antibiotic resistance. This study aimed to investigate the rate of HAIs in Iran. In this multi-centre study, the rate of HAIs was calculated based on the data collected through Iranian nosocomial infections surveillance for patients with HAIs, as well as through hospital statistics and information systems on hospital-related variables. Data were analysed using Stata software; in addition, ArcGIS was used for plotting the geographical distribution of HAIs by different provinces. The mean age of the 107 669 patients affected by HAIs was 52 ± 26.71 years. Just over half (51.55%) of the patients were male. The overall rate of HAIs was 26.57 per 1000 patients and 7.41 per 1000 patient-days. The most common HAIs were urinary tract infections (26.83%; 1.99 per 1000 patient-days), ventilator-associated events (20.28%; 1.5 per 1000 patient-days), surgical-site infections (19.73%; 1.45 per 1000 patient-days) and bloodstream infections (13.51%; 1 per 1000 patient-days), respectively. The highest rate of HAIs was observed in intensive care units. Device, catheter and ventilator-associated infections accounted for 38.72%, 18.79% and 16% of all HAIs, respectively. Based on the results, HAIs are common in intensive care units, and urinary tract infections and device-related infections are more prevalent in Iran. To reduce HAIs it is recommended to implement appropriate policies and interventions, train staff about the use of devices, and prepare and update protocols and guidelines for improving the quality of care.

Serial interval and time-varying reproduction number estimation for COVID-19 in western Iran.

There is no report on the serial interval (SI) of coronavirus disease 2019 (COVID-19) in Iran, the present report aims to estimate the SI and time-varying R of COVID-19 in western Iran. In this study, there were 1477 confirmed, probable and suspected cases of severe acute respiratory syndrome coronavirus 2 for Kermanshah from 22 February to 9 April. The close contacts of the confirmed cases were identified using telephone follow up of patients and their contacts. The SI distribution was used as an alternative. We fitted different models using the clinical onset dates of patients with their close contact (infector-infectee). Also, we applied a 'serial interval from sample' approach as a Bayesian methodology for estimating reproduction number. From 22 February to 29 March, 247 COVID-19 cases were confirmed by RT-PCR. Close contact between 21 patients (21 infector-infectee pairs), including 12 primary cases and 21 secondary cases, was confirmed. The mean and standard deviation of the SI were estimated as 5.71 and 3.89 days. The R varied from 0.79 to 1.88 for a 7-day time-lapse and ranged from 0.92 to 1.64 for a 14-day time-lapse on raw data. Also, the R varied from 0.83 to 1.84 for 7-day time-lapse and from 0.95 to 1.54 for a 14-day time-lapse using moving average data, respectively. It can be concluded that the low reproduction number for COVID-19 in Kermanshah province is an indication of the effectiveness of preventive and interventive programmes such as quarantine and isolation. Consequently, continuing these preventive measures is highly recommended.

Boron-Templated Dimerization of Allylic Alcohols To Form Protected 1,3-Diols via Acid Catalysis.

We report an unprecedented boron-templated dimerization of allylic alcohols that generates a 1,3-diol product with two stereogenic centers in high yield and diastereoselectivity. This acid-catalyzed reaction is achieved via in situ formation of a boronic ester intermediate that facilitates selective cyclization and formation of a cyclic boronic ester product. High yields are observed with a variety of allylic alcohols, and mechanistic studies confirm the role of boron as a template for the reaction.

C-N Bond Formation from Allylic Alcohols via Cooperative Nickel and Titanium Catalysis.

Amination of allylic alcohols is facilitated via cooperative catalysis. Catalytic Ti(O- i-Pr)4 is shown to dramatically increase the rate of nickel-catalyzed allylic amination, and mechanistic experiments confirm activation of the allylic alcohol by titanium. Aminations of primary and secondary allylic alcohols are demonstrated with a variety of amine nucleophiles. Diene-containing substrates also cyclize onto the nickel allyl intermediate prior to amination, generating carbocyclic amine products. This tandem process is only achieved under our cooperative catalytic system.

The additive effect of excimer laser on non-cultured melanocyte-keratinocyte transplantation for the treatment of vitiligo: a clinical trial in an Iranian population.

BACKGROUND: Non-cultured cellular grafting is specified for stable vitiligo treatment as a novel surgical technique, however, the additive effect of excimer laser on melanocytes-keratinocytes transplantation (MKT) have not experienced yet. OBJECTIVE: To assay the additive effect of excimer laser on MKT for the treatment of vitiligo in an Iranian population. METHODS AND MATERIALS: In this non-randomized clinical trial, 39 patches were evaluated. Nine patches treated by MKT alone, 10 patches treated by MKT and excimer laser, 10 patches treated with excimer alone and 10 patches left without any treatments as control patches. RESULTS: In the patches treated with excimer, the percentage reduction of depigmented area from baseline varied, ranging from 0 to 43.9%. In the nine patches treated with non-cultured MKT, the median percentage reduction of depigmented area from baseline was 15.9%. The median percentage reduction of depigmented area in excimer + MKT was 41.9% .In the untreated patches, the median percentage reduction of depigmented area was 0.1%. After controlling for the effect of 'depigmented area at baseline', significant reductions were observed in depigmented area of the patches treated with combination therapy of excimer and non-cultured MKT in comparison with the other therapies and untreated patches. CONCLUSION: Although pigmentation in our patients was lower than previous reports from Iran and other countries, however, we signified adding excimer to MKT increased the pigmentation rate in treated patches. Further investigations are recommended with longer follow-up and larger series to validate the findings reported here.

Simultaneous isocratic separation of phenolic acids and flavonoids using micellar liquid chromatography.

The simultaneous isocratic separation of a mixture of five phenolic acids and four flavonoids (two important groups of natural polyphenolic compounds with very different polarities) was investigated in three different RPLC modes using a hydro-organic mobile phase, and mobile phases containing SDS at concentrations below and above the critical micellar concentration (submicellar LC and micellar LC (MLC), respectively). In the hydro-organic mode, methanol and acetonitrile; in the submicellar mode methanol; and in the micellar mode, methanol and 1-propanol were examined individually as organic modifiers. Regarding the other modes, MLC provided more appropriate resolutions and analysis time and was preferred for the separation of the selected compounds. Optimization of separation in MLC was performed using an interpretative approach for each alcohol. In this way, the retention of phenolic acids and flavonoids were modeled using the retention factors obtained from five different mobile phases, then the Pareto optimality method was applied to find the best compatibility between analysis time and quality of separation. The results of this study showed some promising advantages of MLC for the simultaneous separation of phenolic acids and flavonoids, including low consumption of organic solvent, good resolution, short analysis time, and no requirement of gradient elution.

Separation optimization of aniline and seven 4-substituted anilines in high-submicellar liquid chromatography using empirical retention modeling and Derringer's desirability function.

The separation optimization of aniline and seven 4-substituted derivatives in high-submicellar LC was performed using an interpretive optimization strategy and Derringer's desirability function. Description of the retention of solutes was carried out through several hyperbolic and logarithmic retention models using the retention data of five mobile phases of SDS (0.06-0.12 M) and methanol (50-70% v/v) at pH 3. Among the investigated models, a logarithmic retention model logk=c0+c1φ+c2[S]+c12φ[S]+d12(φ[S])0.5 showed the best prediction capability and was used to predict the solute retention factors. A grid search program was used to calculate the retention times of each solute, based on the best retention model, for all combinations of SDS and methanol concentrations in the factor space. Two different chromatographic goals, analysis time and retention differences between adjacent peaks, were evaluated simultaneously using Derringer's desirability function for each mobile phase conditions in the grid search. Optimal mobile phase composition for separation of eight anilines was found to be 0.119 M SDS and 53% v/v methanol. Under these conditions, full resolutions with a reasonable analysis time (22 min) were obtained. At the optimal condition, a good agreement was observed between predicted and experimental values of the retention times.

Separation optimization of quercetin, hesperetin and chrysin in honey by micellar liquid chromatography and experimental design.

The chemometrics approach was applied for the separation optimization of flavonoid markers (quercetin, hesperetin and chrysin) in honey using micellar liquid chromatography (MLC). The investigated method combines SPE of flavonoids from honey using C(18) cartridge and their separation and quantification by micellar liquid chromatography. A two level full factorial design was carried out to evaluate the effect of four experimental factors including concentration of SDS, alkyl chain length of the alcohol used as the organic modifier (N), volume percentage of the organic modifier (V(m)) and volume percentage of acetic acid (AcOH) in mobile phase on analytes retention times. Experiments for analytes retention times modeling and optimization of separation were performed according to central composite design. Multiple linear regression method was used for the construction of the best model based on experimental retention times. Pareto optimal method was used to find suitable compatibility between resolution and analysis time of analytes in honey. The optimum mobile phase composition for separation and determination of analytes in honey were [SDS]=0.124 mol/L; 7.8% v/v ethanol and 5.0% v/v AcOH. Limits of detection and linear range of flavonoid markers were 0.0079-0.0126, 0.05-50.0 mg/L, respectively.

Repair of iatrogenic large colon perforation using laparoscopic methods. Case report and review of the literature.

Iatrogenic perforation of the colon during elective colonoscopy is a serious complication. Surgical treatment remains the standard of care. We report a patient with a large colonic perforation that occurred during a screening colonoscopy, successfully repaired with laparoscopic methods. Although the safety and efficacy of this approach is not entirely established, laparoscopy can be used to treat iatrogenic colonic perforation when the defect is readily recognized, easily accessible for closure and the bowel preparation is excellent. A laparoscopic approach to treat iatrogenic colon perforation results in decreased morbidity and hospital stay, in addition to a shorter incision length compared to an open method. In those cases where it is feasible and the surgical skill exists, a laparoscopic attempt at colon repair should probably be the initial clinical approach..

A simple and practical method in treatment of ingrown nails: splinting by flexible tube.

BACKGROUND: The ingrown nail (or onychocryptosis) is a common problem that occurs mostly in the big toe and causes high amounts of morbidity in affected patients. Many therapeutic methods have been described, most of them leading to severe damage to the nail or to frequent relapses. The nail splinting technique is a successful, simple and non-invasive therapeutic method for treating ingrown nails. OBJECTIVE: To determine efficacy of the plastic tube insertion technique in patients with ingrown toenail and its use as a standard treatment. MATERIALS AND METHODS: We encountered 32 cases (age range 9-67 years) of ingrown toenails in this clinical trial. All of the patients were treated using the plastic nail tube insertion technique for 7 to 15 days. Patients were examined daily for the first 3 days of treatment and were evaluated 3 and 6 months after treatment. All patients were followed up by a single observer. RESULTS: Recurrence was seen in only two patients after 6 months of treatment (6.25%). CONCLUSION: The low recurrence rate using the nail splinting technique in the treatment of ingrown toenail, as well as its simple application, shows that this treatment constitutes an effective, non-invasive method. It appears that this technique can substitute other more invasive surgical methods, particularly in the early stages of this disease.