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1.
BMC Health Serv Res ; 21(1): 943, 2021 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-34503503

RESUMO

BACKGROUND: The Gambia has one of the lowest survival rates for breast cancer in Africa. Contributing factors are late presentation, delays within the healthcare system, and decreased availability of resources. We aimed to characterize the capacity and geographic location of healthcare facilities in the country and calculate the proportion of the population with access to breast cancer care. METHODS: A facility-based assessment tool was administered to secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia. GPS coordinates were obtained, and proximity of service availability and population analysis were performed. Distance thresholds of 10, 20, and 45 km were chosen to determine access to screening, pathologic diagnosis, and surgical management. An additional population analysis was performed to observe the potential impact of targeted development of resources for breast cancer care. RESULTS: All 102 secondary and tertiary healthcare facilities and private medical centers and clinics in The Gambia were included. Breast cancer screening is mainly performed through clinical breast examination and is available in 52 facilities. Seven facilities provide pathologic diagnosis and surgical management of breast cancer. The proportion of the Gambian population with access to screening, pathologic diagnosis, and surgical management is 72, 53, and 62%, respectively. A hypothetical targeted expansion of resources would increase the covered population to 95, 62, and 84%. CONCLUSIONS: Almost half of the Gambian population does not have access to pathologic diagnosis and surgical management of breast cancer within the distance threshold utilized in the study. Mapping and population analysis can identify areas for targeted development of resources to increase access to breast cancer care.


Assuntos
Neoplasias da Mama , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Gâmbia/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Programas de Rastreamento
2.
Am J Nephrol ; 52(7): 572-581, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34293738

RESUMO

INTRODUCTION: Ferric citrate (FC) is indicated as an oral iron replacement for iron deficiency anemia in adult patients with chronic kidney disease (CKD) not on dialysis. The recommended starting dose is one 1-g tablet three times daily (TID). This study investigated long-term efficacy and safety of different FC dosing regimens for treating anemia in nondialysis-dependent CKD (NDD-CKD). METHODS: In this phase 4, randomized, open-label, multicenter study, patients with anemia with NDD-CKD (estimated glomerular filtration rate, ≥20 mL/min and <60 mL/min) were randomized 1:1 to one FC tablet (1-g equivalent to 210 mg ferric iron) TID (3 g/day) or 2 tablets twice daily (BID; 4 g/day). At week 12, dosage was increased to 2 tablets TID (6 g/day) or 3 tablets BID (6 g/day) in patients whose hemoglobin (Hb) levels increased <0.5 g/dL or were <10 g/dL. Primary endpoint was mean change in Hb from baseline to week 24. RESULTS: Of 484 patients screened, 206 were randomized and 205 received FC. Mean (standard deviation) changes from baseline in Hb at week 24 were 0.77 (0.84) g/dL with FC TID 3 g/day and 0.70 (0.98) g/dL with FC BID 4 g/day. DISCUSSION/CONCLUSIONS: FC administered BID and TID for 48 weeks was safe and effective for treating anemia in this population, supporting potentially increased dosing flexibility.

3.
World J Surg ; 45(10): 3019-3026, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34312694

RESUMO

BACKGROUND: The Syrian conflict has produced one of the largest refugee crises in modern times. Lebanon has taken in more Syrian refugees per capita than any other nation. We aimed to study the burden of surgical disease and access to surgical care among Syrian refugees in Lebanon. METHODS: This study was designed as a convenient cross-sectional cluster-based population survey of all refugee camps throughout the Bekaa region of Lebanon. We used a modified version of the Surgeons OverSeas Assessment of Surgical Need to identify surgical conditions and barriers to care access. The head of household of each informal tented settlement provided demographic information after which two household members were randomly chosen and administered the survey. RESULTS: A total of 1,500 individuals from 750 households representing 21 camps were surveyed. Respondents had a mean age of 36.6 (15.0) years, 54.6% were female, and 59% were illiterate. Nearly 25% of respondents reported at least one surgical condition within the past year, most commonly involving the face, head, and neck region (32%) and extremities (22%). Less than 20% of patients with a surgical condition reported seeing any healthcare provider, > 75% due to financial hardship. CONCLUSIONS: The prevalence of surgical disease among Syrian refugees is very high with a fourth of refugees suffering from one or more surgical conditions over the past year. The surgical needs of this vulnerable population are largely unmet as financial reasons prevent patients from seeking care. Local and humanitarian efforts need to include increased access to surgical care.


Assuntos
Refugiados , Adulto , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Síria , Populações Vulneráveis
4.
Beilstein J Org Chem ; 16: 1706-1712, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32733614

RESUMO

An efficient one-pot synthesis of N 2-(tetrazol-5-yl)-6-aryl/heteroaryl-1,3,5-triazine-2,4-diamine derivatives was developed by reacting 5-amino-1,2,3,4-tetrazole with aromatic aldehydes and cyanamide in pyridine under controlled microwave heating with high yields. X-ray crystallography confirmed the structure of the obtained products.

5.
Toxins (Basel) ; 12(7)2020 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-32664544

RESUMO

Bee venom (BV) is a rich source of secondary metabolites from honeybees (Apis mellifera L.). It contains a variety of bioactive ingredients including peptides, proteins, enzymes, and volatile metabolites. The compounds contribute to the venom's observed biological functions as per its anti-inflammatory and anticancer effects. The antimicrobial action of BV has been shown in vitro and in vivo experiments against bacteria, viruses, and fungi. The synergistic therapeutic interactions of BV with antibiotics has been reported. The synergistic effect contributes to a decrease in the loading and maintenance dosage, a decrease in the side effects of chemotherapy, and a decrease in drug resistance. To our knowledge, there have been no reviews on the impact of BV and its antimicrobial constituents thus far. The purpose of this review is to address the antimicrobial properties of BV and its compounds.


Assuntos
Anti-Infecciosos/uso terapêutico , Venenos de Abelha/uso terapêutico , Abelhas/metabolismo , Animais , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Antivirais/uso terapêutico , Venenos de Abelha/metabolismo , Humanos , Metabolismo Secundário
6.
Braz J Anesthesiol ; 70(2): 178-183, 2020.
Artigo em Português | MEDLINE | ID: mdl-32475699

RESUMO

BACKGROUND: Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients. METHODS: In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique. RESULTS: Sensory distribution of the block in the four patients studied was found to cover the area between the T11-12 and L4-5 dermatomes. Spread of the injectate was confirmed via an A-P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases. CONCLUSIONS: The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.

7.
Rev. bras. anestesiol ; 70(2): 178-183, Mar.-Apr. 2020. graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1137152

RESUMO

Abstract Background: Effective pain management is essential for successful rehabilitation and enhanced recovery after joint arthroplasty. The Quadratus Lumborum Block (QLB) has mostly been described for abdominal surgery, but has also recently been applied to hip surgery patients. Methods: In the following cases series, we suggest a modification of the TQL block described as Paraspinous Sagittal Shift QL block. We hypothesize that this approach may allow better LA spread to the lumbar nerve roots. Such technique involves a craniocaudal approach of LA injection between the QL and PM muscles behind the Anterior Thoracolumbar Fascia (ATLF) at the level of L4. Cases were provided with combined GA and PSSS modification of QL block via a single shot or catheter technique. Results: Sensory distribution of the block in the four patients studied was found to cover the area between the T11-12 and L4-5 dermatomes. Spread of the injectate was confirmed via an A-P fluoroscopy imaging of the lumbosacral spine after injection of a mixture of LA and a contrast in the plane between the QL and PM muscles in two cases. Conclusions: The PSSS technique for TQL block may be beneficial as a part of multimodal analgesia for hip surgeries. This technique may be a safe alternative to psoas compartment block; however, future comparative studies are recommended. The PSSS technique for TQL block also may provide an easy access for catheter insertion.


Resumo Justificativa: O controle efetivo da dor é essencial para a reabilitação bem-sucedida e melhor recuperação após artroplastia. O bloqueio do quadrado lombar tem sido descrito principalmente para cirurgia abdominal, mas recentemente também tem sido usado para pacientes submetidos a cirurgia de quadril. Método: Na série de casos a seguir, sugerimos modificação na técnica do bloqueio transmuscular do quadrado lombar descrita como bloqueio do Quadrado Lombar Paraespinhoso Sagital (PES). Nossa hipótese é de que a técnica permitiria melhor dispersão do anestésico local para as raízes dos nervos lombares. Tal técnica envolve acesso craniocaudal para injeção do anestésico local entre os músculos quadrado lombar e psoas maior atrás da Fáscia Toracolombar Anterior (FTLA) no nível de L4. Os casos foram submetidos a anestesia geral combinada a técnica modificada PES para bloqueio do quadrado lombar via injeção única ou cateter. Resultados: Verificou-se que a distribuição sensorial do bloqueio nos quatro pacientes estudados cobriu a área entre os dermátomos T11-12 e L4-5. A dispersão do anestésico injetado foi confirmada via fluoroscopia A-P da coluna lombo-sacral após injeção, em dois casos, de solução de anestésico local e contraste no plano entre os músculos quadrado lombar e psoas maior. Conclusões: A técnica PES para bloqueio transmuscular do quadrado lombar pode ser benéfica como componente da analgesia multimodal para cirurgias de quadril. A técnica pode ser alternativa segura para bloqueio do compartimento psoas; entretanto, estudos comparativos futuros são recomendados. A técnica PES para bloqueio transmuscular do quadrado lombar pode também fornecer acesso fácil para inserção do cateter.

8.
Indian J Anaesth ; 64(1): 49-54, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32001909

RESUMO

Background and Aims: Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound-guided erector spinae plane block (ESPB) versus parasagittal in-plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy. Methods: One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in-plane paravertebral block and ESPB group receiving erector spinae plane block. The block in the 1st six cases in each group was done by an experienced consultant as a demonstration for three anaesthesia residents not experienced in either block. Primary endpoint was assessing success rate of the blocks. Secondary endpoint was the haemodynamic response to skin incision and postoperative analgesia. Results: All patients were females undergoing modified radical mastectomy. Success rate among residents was 100% in ESPB versus 77.8% in PARA group (P = 0.002). Duration to perform the block was less in ESPB group (4.39 ± 1.2 min) than PARA group (8.18 ± 2.42 min) (P < 0.0001). Guidance frequency by consultants was significantly higher in PARA than ESPB group. Time to 1st analgesic requirement and morphine consumption postoperatively were insignificant between the groups. There was no significant difference regarding haemodynamics. Conclusion: ESPB may be a simple and safe alternative to parasagittal in-plane paravertebral block to provide postoperative analgesia in modified radical mastectomy especially in novice practitioners. It provides equivalent profile of postoperative analgesia with less time to perform the block.

9.
PLoS One ; 14(10): e0223285, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31589644

RESUMO

PURPOSE: Decreasing the risk of catheter related bloodstream infections (CRBSIs) remains a key focus for improving outcomes and reducing cost of care for hemodialysis (HD) patients. Recent studies demonstrate CRBSI rates can be improved by managing bacterial colonization at the catheter exit site. Herein we present the results of a study documenting the clinical performance of the NexSite HD catheter, a new tunneled central venous catheter which incorporates Exit Site Management (ESM) technology. METHODS: We conducted an observational study using a prospective, multi-center registry of HD patients implanted with the NexSite HD catheter. The primary endpoint for the study was CRBSI rate for a period up to 180-days following catheter placement. Secondary endpoints included device placement success rate, exit site healing, development of an exit site or tunnel infection, and early or late non-infectious catheter-related complications. All reasons for early non-elective catheter removal were recorded. RESULTS: A total of 115 HD patients at 6 sites were included in the final analysis. Cumulative catheter use was 10,924 days with a mean duration of 95 days. Seven patients experienced CRBSIs during the study period resulting in a CRBSI rate of 0.64 per 1,000 catheter-days. Seventy-four patients (64.3%) had either elective catheter removal (n = 56) or utilized the catheter for the entire 180-day observation period (n = 18). Thirty-five patients (30%) underwent non-elective device removal either due to CRBSI (n = 5), low flow (n = 16), exit site issues (n = 7), or for other causes (n = 7). Six patients died during the observation period with 1 death due to CRBSI-associated complications and the remaining 5 deaths attributed to non-device related causes. CONCLUSION: Our findings demonstrate that the NexSite HD catheter equipped with ESM technology can achieve a CRBSI rate in compliance with the NKF KDOQI (National Kidney Foundation Kidney Disease Outcome Quality Initiatives) Clinical Performance Guidelines stated goal of less than 1.0/1,000 catheter-days when used in hemodialysis patients using current standard of care nursing protocols.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais/efeitos adversos , Diálise Renal/métodos , Adulto , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/efeitos adversos , Diálise Renal/instrumentação
10.
Mar Drugs ; 17(9)2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443597

RESUMO

Cancer remains one of the most lethal diseases worldwide. There is an urgent need for new drugs with novel modes of action and thus considerable research has been conducted for new anticancer drugs from natural sources, especially plants, microbes and marine organisms. Marine populations represent reservoirs of novel bioactive metabolites with diverse groups of chemical structures. This review highlights the impact of marine organisms, with particular emphasis on marine plants, algae, bacteria, actinomycetes, fungi, sponges and soft corals. Anti-cancer effects of marine natural products in in vitro and in vivo studies were first introduced; their activity in the prevention of tumor formation and the related compound-induced apoptosis and cytotoxicities were tackled. The possible molecular mechanisms behind the biological effects are also presented. The review highlights the diversity of marine organisms, novel chemical structures, and chemical property space. Finally, therapeutic strategies and the present use of marine-derived components, its future direction and limitations are discussed.


Assuntos
Antineoplásicos/farmacologia , Organismos Aquáticos/química , Produtos Biológicos/farmacologia , Neoplasias/tratamento farmacológico , Animais , Antineoplásicos/isolamento & purificação , Antineoplásicos/uso terapêutico , Produtos Biológicos/isolamento & purificação , Produtos Biológicos/uso terapêutico , Ensaios Clínicos como Assunto , Modelos Animais de Doenças , Humanos , Resultado do Tratamento
11.
J Clin Densitom ; 22(3): 382-390, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30292570

RESUMO

One of the best methods for diagnosing bone disease in humans is site-specific and total bone mineral density (BMD) measurements by Dual-energy X-ray Absorptiometry (DXA) machines. The basic disadvantage of this technology is inconsistent BMD measurements among different DXA machines from different manufacturers due to different image analysis algorithms. The objective of the present study was to apply artificial neural networks (ANNs) to estimate total BMD for diagnosing a population of Egyptians with and without pathology, using extracted features from DXA-DICOM images based on the Histogram and Binary algorithms as compared to reference BMD measurements by DXA machine. The sample size comprised 3000 male and female participants with an age range 22-49 years, who were referred to us for diagnosis and/or treatment and for DXA total body scans in the period from January 2016 till December 2017. We constructed an entry computer data-logging visible unit, where we applied morphological operations to get a specific bone image, and used their extracted feature vectors as inputs to ANNs with cascade training, gathering, and testing for DXA-DICOM image processing. The multilayer feed-forward ANN set up its initial weights, carried out training and initiated the recall mode, and finally observed its decision and interaction based on estimated BMD. The ANN construction was carried out using a 3-layer architecture, with one hidden layer of 85 neurons. The input layer has neuron numbers equal to 256 for the Histogram and 77,365 for Binary algorithms, respectively. Total BMD estimation performance based on the Binary algorithm was capable of identifying all DXA-DICOM images with an accuracy of 100% for the training, cross-validation, and testing of the ANN phases. We believe this strategy will represent the means for standardizing bone measurements of all DXA machines, regardless of the manufacturer.


Assuntos
Absorciometria de Fóton/métodos , Densidade Óssea , Processamento de Imagem Assistida por Computador/métodos , Redes Neurais de Computação , Osteoporose/diagnóstico por imagem , Absorciometria de Fóton/instrumentação , Adulto , Algoritmos , Estudos de Casos e Controles , Egito , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
J Anesth ; 32(5): 725-730, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30167783

RESUMO

BACKGROUND: This study compared proximal and distal approaches of intercostobrachial nerve block (ICBNB) combined with infraclavicular brachial plexus block (ICBPB) during superficialization of arteriovenous fistula. METHODS: Seventy adult patients were randomized to receive ICBPB and 6 ml 0.25% bupivacaine at the level of the 3rd rib in the anterior axillary line between pectoralis minor and serratus anterior muscles (group P) or subcutaneously along the medial side of the upper arm (group D). The primary outcome was the achievement of complete sensory block. Secondary outcomes were onset of analgesia, volume of local anesthetic (LA) supplementation, fentanyl administration, success rate, and conversion to general anesthesia (GA). RESULTS: Complete sensory block in the medial side of the upper arm was achieved in 91% of patients in group P and 51% in group D. Failure rate of ICBNB was higher in group D (49%) than group P (14%). Conversion to GA was determined by the attending anesthesiologist in 26% of patients in group D and 0% in group P. LA supplementation was required in 5 patients in group P and 11 patients in group D, and the mean volume of LA was statistically higher in group D than group P (9.5 ± 1.5, 7.5 ± 2 ml, respectively). Onset of sensory block was faster in group P than group D (8.75 ± 1.67 and 10 ± 2.14 min, respectively). No differences were observed regarding fentanyl administration. CONCLUSION: ICBNB proximal approach provides a high success rate with less amount of rescue analgesia compared to the distal approach.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/métodos , Bupivacaína/administração & dosagem , Fentanila/administração & dosagem , Adulto , Analgesia/métodos , Braço , Derivação Arteriovenosa Cirúrgica/métodos , Axila , Feminino , Humanos , Nervos Intercostais , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
13.
Indian J Anaesth ; 62(5): 376-380, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29910496

RESUMO

Background and Aims: The palatal defect and abnormal dentition in cleft palate make mask ventilation and laryngoscopy difficult. This study aimed to assess the effect of feeding obturator on laryngeal view in unilateral complete cleft palate. Methods: Ninety non-syndromic infants scheduled for the first stage correction of complete unilateral cleft palate were randomised to Group A (no feeding obturator) or Group B (obturator used for induction and intubation). The primary objective was to assess effect of the feeding obturator on the Cormack-Lehane grade on laryngoscopy. Effects on face mask ventilation, easiness of laryngoscopy and intubation and the side effects were also measured. Results: Ninety patients completed the study. There was no statistically significant difference between the two groups regarding the CL grade (P < 0.1). However duration for intubation was significantly longer in Group A than Group B (31.4 ± 12.8 vs. 23.4 ± 40.7 sec, P < 0.001). The degree of difficulty of face mask ventilation was significantly greater in Group A than Group B (P < 0.008). Attempts for successful intubation and manoeuvres for successful intubation were significantly more in Group A than B (P < 0.05). Trauma occurred in ten patients in Group A relative to no patients in Group B. Conclusion: Use of a pre-sized obturator in infants with complete unilateral cleft palate does not improve the laryngoscopic view. However, it results in better face mask ventilation and easier and faster laryngoscopy and intubation.

15.
Mini Rev Med Chem ; 18(12): 992-1007, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-27903227

RESUMO

Progress in the chemistry of cyclic enamino-nitriles based on the advanced synthetic methodologies is reported. Due to the recent accomplishment, it becomes possible to reactivate these molecules toward electrophiles, nucleophiles and as electron rich dienes in 2+3 dipolar additions and in 4+2 cycloadditions reactions. Synthesizing the poly functionalized 4H-pyrans and their fused derivatives is a fascinating field with a multitude of biological implications such as antitumor, cardiotonic, hepatoprotective, antihypertensive, antibronchitis, as well antifungal activity. This work was conducted with particular emphasis on reviewing the work done on the cyclic enamines since 1990 up till now in order to highlight in more details the synthetic pathways, interactions and the biological activities, Furthermore; we referred to the recent original data of our group contributions within this field.


Assuntos
Aminas/química , Ésteres/química , Compostos Heterocíclicos de 4 ou mais Anéis/química , Nitrilas/química , Aminas/síntese química , Cristalografia por Raios X , Ésteres/síntese química , Compostos Heterocíclicos de 4 ou mais Anéis/síntese química , Modelos Moleculares , Estrutura Molecular , Nitrilas/síntese química
16.
J Anesth ; 31(6): 846-851, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28936612

RESUMO

BACKGROUND: Ultrasound has growing applications in airway management during anesthesia. The aim of the present study was to evaluate the feasibility of real-time ultrasound-guided tracheal intubation in patients with cervical spine immobilization relative to fiberscope-guided tracheal intubation. PATIENTS AND METHODS: This randomized controlled study was carried out on 266 adult patients who have a rigid neck collar in place for cervical spine immobilization and were randomly allocated into two equal groups. All patients were subjected to the same anesthetic protocol. After full neuromuscular blockade, neck collar was removed and tracheal intubation was done in the neutral position. In group A, the trachea was intubated guided by a 5-12-MHz linear ultrasound probe attached to a Sonoscape A5 ultrasound machine. In group B, the trachea was intubated by an endotracheal tube mounted over a fiberscope (Karl Storz, working length 65 cm, distal tip diameter 5.6 mm). Hemodynamic measurements and oxygen saturation were recorded. Tracheal intubation criteria for both groups including duration of the intubation procedure, number of intubation attempts, success rate at each attempt, and the lowest oxygen saturation recorded during tracheal intubation were recorded. RESULTS: Ultrasound and fiberscope achieved comparable time for tracheal intubation (57 ± 12 vs. 55 ± 10 s), respectively. Success rate of tracheal intubation at the first attempt was higher in the fiberscope group than the ultrasound group, with a P value of 0.032. The overall success rate was not significantly different between the two groups. CONCLUSIONS: Ultrasound-guided tracheal intubation showed a lower first attempt success rate in patients with cervical spine immobilization compared to fiberscope-guided tracheal intubation but the overall success rates were comparable. Ultrasound can be an alternative technique for guiding tracheal intubation in patients with cervical spine immobilization. REGISTRY NUMBER: PACTR201602001476292.


Assuntos
Manuseio das Vias Aéreas/métodos , Anestesia/métodos , Intubação Intratraqueal/métodos , Bloqueio Neuromuscular/métodos , Adulto , Anestesiologia , Feminino , Humanos , Imobilização , Masculino , Traqueia
17.
Int J Pharm ; 504(1-2): 125-33, 2016 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-27036397

RESUMO

To overcome the rapid enzymatic degradation and low transfection efficiency of siRNA, the delivery carriers for siRNA is a therapeutic demand to increase its stability. Gold nanoparticles (AuNPs) modified by branched polyethyleneimine (bPEI) were developed as an efficient and safe intracellular delivery carriers for siRNA. The current study implied that siRNA designed against an oncogene c-Myc could be delivered by a modified AuNPs complex without significant cytotoxicity. The comparative semi-quantitative and quantitative real time PCR were used to measure the c-Myc gene expression after transfection with naked siRNA and siRNA/bPEI/AuNPs, but AuNPs interfered with PCR. However, the c-Myc protein translation was successfully detected in the transfected HuH7 cells with naked siRNA and siRNA/bPEI/AuNPs and it was found to be inhibited by siRNA/bPEI/AuNPs more than naked siRNA. The results validate the successful silencing of c-Myc gene. Accordingly, it may confirm the promising and effective delivery of siRNA by bPEI/AuNPs. The complex enhances the cellular uptake of siRNA without significant cytotoxicity and confirms that bPEI modified AuNPs could be used as a good candidate for safe cellular delivery of siRNA.


Assuntos
Ouro/administração & dosagem , Nanopartículas Metálicas/administração & dosagem , RNA Interferente Pequeno/administração & dosagem , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Citratos/química , Expressão Gênica , Ouro/química , Humanos , Lipídeos/administração & dosagem , Neoplasias Hepáticas/metabolismo , Nanopartículas Metálicas/química , Proteínas Proto-Oncogênicas c-myc/genética , Proteínas Proto-Oncogênicas c-myc/metabolismo , RNA Interferente Pequeno/química
18.
Middle East J Anaesthesiol ; 23(6): 625-29, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29939700

RESUMO

Abstract: The design of the endotracheal tube might be an important factor in the incidence of injurious complications during nasotracheal intubation. Aim of the work: Primary aim: to compare the parker flex tip (PFT) and the preformed nasal (PNT) tubes regarding the ease of insertion during nasotracheal intubation in children undergoing adenotonsillectomy. Secondary aim: to verify the incidence of traumatic complications of both types of tubes during nasotracheal intubation in children undergoing adenotonsillectomy. Patients and methods: 100 patients aged between 4 and 10 years ASA physical status I-II scheduled for adenotonsillectomy were divided into two groups; Group PFT: Patients were nasally intubated using the parker flex-tip endotracheal tube, Group PNT: Patients were nasally intubated using the preformed nasal tube. Ease of insertion of the ETT, degree of trauma and the time of intubation was measured. Results: ETT was easily inserted without any resistance in 24% of patients of the PFT group versus 12% of patients in the PNT group. ETT could not be passed through the right or left nostrils in 20% of patients of the PNT group relative to only 4% of patients of the PFT group. Incidence of trauma to the nasal mucosa was significantly higher in patients of the PNT group than patients of the PFT group. Duration of intubation was statistically significantly longer among patients of the PNT group than patients of the PFT group. Conclusions: It seems that the flexible tapered tip of the PFT tube has led to easier insertion through the nasal passages as well as less trauma to the nasal mucosa in children having nasopharyngeal pathology in the form of adenoids. At the same time, the duration of intubation was less in the PFT group relative to the control group in spite of the more familiarity of the investigator with the standard portex tube.


Assuntos
Adenoidectomia/instrumentação , Intubação Intratraqueal/instrumentação , Tonsilectomia/instrumentação , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos
19.
Mol Divers ; 19(3): 625-51, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25894364

RESUMO

Developments made since 2010 in the utilization of multi-component reactions as green efficient methodologies for the synthesis of polysubstituted pyrans, thiopyrans, pyridines, and pyrazoles are reviewed and the mechanisms of these processes are discussed. Reference is made to classical older synthetic methods developed earlier in our laboratories.


Assuntos
Técnicas de Química Sintética/métodos , Química Verde/métodos , Piranos/síntese química , Pirazóis/síntese química , Piridinas/síntese química , Compostos de Sulfidrila/síntese química , Piranos/química , Pirazóis/química , Piridinas/química , Compostos de Sulfidrila/química
20.
Paediatr Anaesth ; 25(4): 421-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25581094

RESUMO

INTRODUCTION: Propofol and midazolam are widely used for pediatric magnetic resonance imaging (MRI) sedation. Increasing depth of sedation may be associated with airway obstruction. A neck collar supporting the mandible and maintaining the head in slight extension may be beneficial in maintaining airway patency. AIM OF THE STUDY: Primary aim: To assess upper airway size with and without a neck collar during pediatric MRI sedation with propofol-midazolam. Secondary aim: To evaluate complications encountered during the procedure. MATERIALS AND METHODS: Sixty patients aged 2-4 years scheduled for MRI of the brain were selected. They were sedated with intramuscular midazolam 0.1 mg·kg(-1) 30 min before the procedure. Patients were sedated with i.v. propofol 1 mg·kg(-1) and continued with 50-100 µg·kg(-1) ·min(-1) . T1 3D fast-field echo axial sequence from the nasopharyngeal roof to subglottic region was taken with and without application of a neck collar. Airway dimensions were measured and analyzed at the base of the tongue, soft palate, and at the epiglottis. RESULTS: At the base of the tongue and soft palate, the cross-sectional area (CSA) and the anteroposterior diameter of the airway were respectively statistically significantly higher when the neck collar was applied. The CSA at the epiglottis was significantly less with application of the neck collar. Complications were not significantly different between the two sequences. CONCLUSION: Application of a soft neck collar in children aged 2-4 years may enhance the retropalatal and retroglossal airway dimensions during pediatric sedation in the supine position.


Assuntos
Manuseio das Vias Aéreas/efeitos adversos , Manuseio das Vias Aéreas/métodos , Sedação Consciente/efeitos adversos , Sedação Consciente/métodos , Hipnóticos e Sedativos/efeitos adversos , Imageamento por Ressonância Magnética/métodos , Midazolam/efeitos adversos , Pescoço , Propofol/efeitos adversos , Obstrução das Vias Respiratórias/induzido quimicamente , Obstrução das Vias Respiratórias/prevenção & controle , Anatomia Transversal , Peso Corporal , Pré-Escolar , Epiglote/anatomia & histologia , Feminino , Humanos , Masculino , Palato Mole/anatomia & histologia , Língua/anatomia & histologia
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