5th Minute Research Articles

Three-Dimensional (3D) Flood Simulation Aids Informed Decision Making: A Case of a Two-Story Underground Parking Lot in Beijing

Flooding in underground spaces, such as subway stations, underground malls, and garages, has increased due to intensified rainfall, urbanization, and population growth. Traditional 2D simulations often overlook crucial vertical flow variations, especially in steep transitions like stairs and ramps. The current study aims to investigate the flood dynamics in large underground geometries by taking a parking lot in Beijing, China, as a study case. The model overcomes the limitations of previous simulations by adapting a full 3D mesh-based simulation with reasonable computational cost. Unlike earlier studies, this model employs a high temporal resolution transient inflow at the inlet to the underground space. Simulation scenarios consider different return periods (5, 20, and 100 years) and inlet water depths, providing an analysis of their impact on flood status in the underground structure. The model generates high spatial–temporal results, enabling precise detection of flood-prone locations, evacuation times, and suggested mitigation techniques. The results recommend evacuating from hazard areas before the 10th minute during extreme flood events. Additionally, the study estimates a 40% increase in flood hazards for scenarios with direct connections between levels. Overall, the study highlights the importance of 3D simulations for accurate risk assessment.

Inclusion Transfer Phenomenon under Unsteady Multiphase Flow during Rheinstahl–Heraeus Vacuum Treatment Process

Inclusion particles are extremely harmful to the quality of steel products, and Rheinstahl–Heraeus (RH) vacuum treatment is the key process to remove the inclusions from molten steel. By coupling analyzing the unsteady gas–liquid flow and decarbonization reaction, the inclusion mass/population conservation model is developed to explore the inclusion particles transfer phenomenon during RH vacuum treatment process. The coupling mathematical models are validated by the metallurgical experimental data. The results show that the predicted inclusion mass concentration in unsteady CO–Ar–molten steel multiphase system has significantly smaller relative error than that in steady Ar–molten steel flow. CO bubble plays a key role in the inclusion transfer phenomenon, which prompts the inclusion transport, the collision‐aggregation, and the removal process. At the 4th minute of vacuum treatment, the average inclusion volume concentration and the average inclusion number density in CO–Ar–molten steel are 72.75% and 64.62% of those in Ar–molten steel, respectively. The average inclusion characteristic radius in CO–Ar–molten steel is 7.33% larger than that in Ar–molten steel.

Research on the effect of post-activation potentiation under different velocity loss thresholds on boxer's punching ability.

This study was conducted in accordance with the principles of velocity-based training theory, with the objective of investigating the effects of post-activation potentiation (PAP) induced by different velocity loss (VL) thresholds (10% vs. 20%) on the punching ability of boxers. In addition, the aim was to determine the velocity loss thresholds and time nodes that produced the optimal activation effect. Twenty-four male elite boxers were randomly assigned to three groups: CON, 10 VL, and 20 VL. All subjects in the three groups underwent an activation intervention involving an 85% of the one-repetition maximum (1RM) squat, with 6-8 repetitions performed in the CON. The number of repetitions in the 20%VL and 10 VL was determined based on the velocity loss monitored by the GymAware PowerTool system. Four time points were selected for observation: the 4th, 8th, 12th and 16th minutes. These were chosen to test the subjects' punching ability. The results demonstrated that activation training at different VL induced a post-activation potentiation in boxers, improving punching ability bilaterally and to a greater extent than in the CON. The dominant side demonstrated the greatest efficacy at the 12th minute under the 20% velocity loss threshold, while the non-dominant side exhibited the greatest efficacy at the 8th minute under the 10% velocity loss threshold.

COMPARATIVE EVALUATION OF CARDIOVASCULAR PARAMETERS OF PROPOFOL / ETOMIDATE FOR ABDOMINAL SURGERIES IN CALVES

The calves presented with abdominal affections requiring surgical interventions were randomly divided into group I and group II with seven animals in each group. All the animals were premedicated with dexmedetomidine at 2 µg/kg body weight, pentazocine at 1 mg/kg body weight and midazolam at 0.2 mg/kg body weight intravenously. In group I and group II, anaesthetic induction was carried out with propofol at 2 mg/kg body weight and etomidate at 0.25 mg/kg body weight intravenously, respectively. Both the groups were maintained in Isoflurane anaesthesia with modified oro-endotracheal tube. The cardiovascular parameters such as heart rate, mean arterial blood pressure, systolic and diastolic blood pressure were monitored during different stages of anaesthesia in both the groups. In both the groups, a significant decrease in heart rate was noticed after premedication and anaesthetic induction. A Significant increase was noticed in systolic blood pressure values after anaesthetic induction and 10th minute of anaesthesia in group I and a highly significant increase was noticed after induction up to 10 minutes in group II. A highly significant increase in diastolic blood pressure was noticed after induction and 10th minute in group I, whereas significant increase was noticed in mean arterial pressure after induction and 15th minute of anaesthesia in group II animals. The cardiovascular parameters recorded in the present study concluded etomidate produced better cardiovascular stability and minimal respiratory depression compared to propofol throughout the anaesthetic period.

7550 Case Report On Concurrent Metastases To The Pituitary And Adrenal From A Primary Breast Cancer

Abstract Disclosure: M.V. David-santos: None. M.C. Isidro: None. Background: Metastatic Cancer to the pituitary gland is a rare condition accounting for 0.5% of all pituitary tumors. It rarely manifests clinically and is often found incidentally. Endocrine dysfunction usually arise, with 38.4% of cases presenting with Diabetes Insipidus, while 37.7% as Panhypopituitarism. On the other hand, prevalence of adrenal metastases is at 0.5 to 3.8% with 43% occurring bilaterally. Primary adrenal insufficiency occurs at 12.4% among those with bilateral metastases. Case: A 32-year old Chinese woman was diagnosed with Stage 4 breast adenocarcinoma ER PR Her2 Neu positive with metastases to the axillary lymph nodes, bone and right adrenal in July 2021. She underwent chemotherapy with Paclitaxel and Trastuzumab then radical mastectomy of the left breast in April 2022.5 months post op, PET scan was done which showed a 11 x 18 x 21 mm pituitary mass. In light of the primary malignancy, lesion was considered a metastatic focus. At that time, patient did not exhibit any neurologic symptoms such as blurring of vision or headaches. No polyuria, polydipsia, nocturia, easy fatigability, nausea or vomiting. Physical examination findings were normal. A hormonal panel showed the following: elevated Prolactin at 150 ng/ml (NV 3-20), normal plasma ACTH IRMA 10 pg/ml (NV < 50 pg/ml), low 8AM plasma cortisol at 1.55 ug/dL (Ref 5- 25 ug/dL), TSH was low at 0.15iIU/ml (0.27-3.75) while FT4 was normal at 0.87 ng/dl (NV 0.68 - 2.56).ACTH stimulation showed low cortisol at the 30th minute and 1st hour post ACTH infusion. Serum sodium and urine Osmolality were both normal. The hyperprolactinemia was attributed to Stalk effect, while the decreased cortisol was considered as central adrenal insufficiency. She was then started on Prednisone 5mg tab daily. Repeat TSH and FT4 5 months after showed normal TSH at 1.209, low FT4 at 5.97 pmol/L (NV 9.01-19.05). She was started on Levothyroxine 50mcg daily for the central hypothyroidism.Repeat Cranial MRI 4 months post diagnosis of the pituitary mass showed increased in its size. An endoscopic transsphenoidal resection and biopsy of the pituitary mass showed metastatic carcinoma of the pituitary gland. Staining of the sellar tumor were compatible with a metastatic carcinoma of breast origin. Intensity-modulated radiation therapy (IMRT) at 400 gray was done for 5 fractions and Trastuzumab was continued. Cranial MRI done 6 months post IMRT showed decreasing size of the pituitary mass to its latest size of 6 x 9 x 13 mm as of November 2023. Latest Whole abdominal CT scan of the adrenals showed clearing of the right adrenal Nodule. Conclusion: Breast cancer may also metastasize to endocrine organs causing hormonal dysfunction. Although curative treatment is no longer the goal for Metastatic breast cancer, prolongation of the quality of life is an important aspect to consider. Hormonal work up, surveillance and hormonal replacement can help in attaining this goal. Presentation: 6/3/2024

Appropriate dose of tranexamic acid in the topical treatment of anterior epistaxis, 500 mg vs 1000 mg: A double-blind randomized controlled trial.

Patients with epistaxis typically visit the emergency department for initial treatment. According to recent studies, tranexamic acid (TXA) is effective in the treatment of epistaxis. This study compared the therapeutic superiority of saline to that of 500 and 1000 mg doses of topical TXA for the treatment of anterior epistaxis. Materials and methods: This phase 4 clinical trial was a randomized, controlled, and double-blind trial. A total of 152 patients were divided into three groups. Group 1 was treated with 1000 mg TXA, Group 2 with 500 mg TXA, and Group 3 with saline. Results: Based on multinomial logistic regression analysis, the bleeding frequency at the 5th minute was 2.9 times and rebleeding status was 4.3 times less in Group 1 (1000 mg TXA) than in Group 3 (saline). There were no differences between the three groups in terms of side effects or salvage therapy. Conclusion: In addition to its superiority in treatment, 1000 mg of TXA is recommended because of the decreased rate of recurrent bleeding and low incidence of side effects.

Findings of Hypotension in Spinal Anesthesia Patients with Lumbar 3-4 And Lumbar 4-5

Background: Hypotension is a common complication associated with spinal anesthesia, often resulting from sympathetic nerve block. Factors such as the type of drug, patient positioning, injection site, dosage, and age influence the incidence of hypotension. Purpose: This study aimed to evaluate the incidence of hypotension in patients receiving spinal anesthesia at the lumbar 3-4 (L3-L4) and lumbar 4-5 (L4-L5) injection sites. Methods: A quantitative descriptive study with a cross-sectional approach was conducted, involving 190 respondents selected via purposive sampling. Univariate data analysis was performed. Findings: Findings indicated that patients receiving spinal anesthesia at the L3-L4 site experienced an average systolic blood pressure decrease of 24.69% and a diastolic decrease of 16.17%. In contrast, patients with L4-L5 injections showed a lesser reduction, with systolic pressure dropping by 15.51% and diastolic pressure by 12.31%. Additionally, the pulse rate decreased progressively within the first 20 minutes following induction. The average pulse rate at the 20th minute was 75.06 for patients with L3-L4 injections and 75.65 for those with L4-L5 injections. Conclusion: The study highlights that the incidence of hypotension varies based on the spinal injection site, with more significant decreases in blood pressure observed in patients receiving injections at L3-L4 compared to L4-L5. These findings have important implications for anesthesia management in clinical practice.

Effectiveness and safety of an inexpensive infant chemical warmer: a pilot study

Introduction. Hypothermia has been widely regarded as a major contributor to neonatal mortality and morbidity. Chemical warming packs used during delivery room resuscitation are associated with decreased rates of hypothermia. The ideal thermal mattress should be inexpensive, electricity-free, reusable, and safe for use in low-resource settings. In this pilot study, we describe the characteristics of a novel, inexpensive chemical warmer developed by the authors. Methods. The novel neonatal chemical warmer consists of two main components. The first component is the chemical warmer bag which is designed for single use, while the other is the container in which the chemical warmer is placed upon activation is reusable. A total of 5 chemical heaters were activated and tested. The goal was to determine whether the temperatures measured on the surface of the warmer were in the optimal range of the chemical heaters available so far. The temperature was measured every 5 minutes at 5 places (corners of the heater and in the middle of the heater), and the maximum measured temperature will be recorded. Temperatures were recorded every 5 minutes as long as the surface temperature measured above 35.9 ºC. Results. By the 5 minutes after activation two and at the 10th minute, all five chemical warmers achieved the desired surface temperature > 36.0 °C (range 38.4 – 40.4 °C.). The length in which the chemical warmer provided the temperatures in the desired range (36.0 – 42.0 °C) varied between 35 to 60 minutes, and we observed that this is highly dependent on starting surface temperatures. Regarding the safety of the surface temperatures produced, no recorded temperatures were above 42.0 °C. The maximum recorded temperature was 40.4 °C in the warmer, with the highest starting temperature in the 10th minute. Conclusion. The novel neonatal chemical warmer performed well when the starting surface temperatures were higher, with the best-performing one being the one with the highest starting temperature of 33.0 °C.

DIAGNOSTIK PAPER ANALYTICAL DEVICE (PAD) MENGGUNAKAN EKSTRAK UBI JALAR UNGU UNTUK DETEKSI BORAKS DALAM MAKANAN

Consuming foods containing borax (tetraborate) will cause health problems. However, in reality, borax is often added to foods such as crackers, meatballs, wet noodles, dumplings. These foods are usually produced by unregistered public members, so their quality is less controlled, so routine monitoring of borax levels in food is needed so that the food quality circulating in the community is maintained and safe for consumption. This research aimed to develop simple method that does not use special instruments to diagnose borax using a Paper Analytical Device (PAD) based on digital imaging using natural reagents from purple sweet potato extract. The research design was laboratory research and development (RnD). The research was conducted at Poltekkes Kemenkes Bandung in January-June 2022. The samples used were borax samples at concentrations of 100, 300, and 500 ppm. The research method was PAD based on digital imaging using Image J. This research was carried out by extracting anthocyanins from purple sweet potatoes, then optimizing the anthocyanin concentration extract; pH; measurement time, determining measurement linearity, and validation by determining % recovery. The research results include that the optimum pH is 9. Optimized measurement time is 3 minutes and is stable until the 5th minute, the linear concentration range of tetraborate is 100-500 ppm tetraborate. In the validation test of the PAD method, a recovery percentage of 87.58-87.95% was obtained for 200 and 300 ppm tetraborate samples. The research result will be able to diagnose and monitor borax in food.

Effect Of Cerclage Suture Type On Pregnancy And Newborn Results: Mersylene Suture Versus Prolene Suture

Purpose: The aim of this study is to compare pregnancy and neonatal outcomes according to the type of the suture material used in the transvaginal cerclage operation. Materials and Methods: Patients who underwent transvaginal cervical cerclage due to cervical insufficiency in a tertiary health center between 2020 and 2024 were evaluated retrospectively. Demographic data regarding cerclage indications (ultrasound-based, prophylactic or physical examination-based), number of weeks of gestation in cerclage, cerclage suture type (prolene, mersilen), gestational week at cerclage insertion and delivery, routes of delivery were recorded. In addition, birth weight, 1st and 5th minute APGAR scores, and neonatal intensive care unit (NICU) requirements were recorded as neonatal parameters. Patients were divided into two groups according to cerclage suture type (mersilene or prolene) and maternal, newborn and pregnancy outcomes were compared between these groups. Results: Comparison of the groups in terms of age, gravidity, parity, number of miscarriages and BMI revealed significantly higher mean gravidity in group 1 compared to group 2 (P0.05). No difference was determined with regard to gestational week at cerclage application, cervical length, cervical dilatation just before cerclage insertion, gestational age at cerclage removal and delivery and birth weight (p>0.05). Groups were comparable in terms of subgroups established according to their numbr number of previous deliveries (p>0.05). Groups were comparable in terms of indications for cerclage insertion (p>0.05). Cesarean delivery rate was 40 % in group 1 while it was 43.6 % in groups 2, no statistical difference was determined in terms of rate of cesarean delivery (p>0.05). Similar number of newborns needed NICU admission between the two groups following delivery (17.5% versus 17.9 %p>0.05). Mean APGAR scores at 1st (6.8 versus 7.4) and 5 th (7.8 versus 8.3) min were comparable between the groups (p>0.05) Conclusion: Although mersilen stitch is commonly preferred, data analysis revealed similar results with prolene stitch in terms of maternal and neonatal outcomes.

Video analysis of music therapy interaction for children experiencing neurodevelopment delay

Children experiencing neurodevelopmental delay have motor, linguistic, and cognitive problems that affect their skills in various domains, especially interpersonal ones. Since music therapy is based on musical exchange, these three case studies explore how child–music therapists’ interactions change within and between sessions. Moreover, we evaluated whether the children’s and parents’ musical interaction changed in everyday life. Three children experiencing neurodevelopmental delay participated in 70 psychodynamic music therapy sessions, relying primarily on musical improvisation techniques. The initial (i.e. pre-test) and final sessions (i.e. post-test) were video recorded and codified with the Kategoriensystem Musik Therapie (KAMUTHE) in the 10th and 30th minutes. Videos were analyzed using the Behavioral Observation Research Interactive Software (BORIS). In addition, parents completed the Music in Everyday Life (MEL) Scale to evaluate how they experienced musical activities with their children. Reliable Change Indexes (RCIs) were calculated to assess significant changes in everyday musical activities. Based on video analysis, three children were more active at the 30th minute and the post-test, while Music Therapists stimulated them less. In addition, therapists adapted the activities and stimuli based on the children’s responses. Based on RCIs, parents reported an increased musical engagement with two children. Music therapy might help children experiencing neurodevelopmental delays modify their interaction style and improve motor and interpersonal skills.

Evaluation of perfusion index to predict hypotension in lower segment caesarean section under spinal anaesthesia

Background: Spinal Anaesthesia is the most popular choice for elective caesarean section. Both general anaesthesia and regional anaesthesia are acceptable techniques for anaesthesia for elective and emergency caesarean sections. Objectives: The study aimed to investigate the role of the perfusion index in predicting the incidence of hypotension following spinal anaesthesia in parturients undergoing elective lower segment caesarean sections. Methods: A prospective, observational study was carried out among sixty parturients posted for elective caesarean section. The study was conducted in the operation theatres of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi. About 60 participants were interviewed for the study. Data were entered and analysed with the help of the Statistical Package for Social Science (SPSS) version.16. Results: Sixty eligible ASAI (American society of anaesthesiologist’s physical status classification) parturients scheduled for elective caesarean section were divided into two groups pre-operatively after determining their baseline Perfusion Index (PI) as those with PI ≤ 3.5 and those with PI > 3.5 using a Masimo® pulse oximeter probe. When comparing the heart rate at time intervals among the two groups, it became increasingly clear that those with baseline PI > 3.5 had generally higher heart rate especially immediately after the block and at 2nd, 4th, 6th,8th, 10th, 12th, 14th and 20th minutes. Conclusion: The study concludes that a Perfusion Index > 3.5 is associated with a higher incidence of hypotension in lower segment caesarean section under spinal anaesthesia. The hemodynamic parameters such as increased heart rate and significantly lower systolic, diastolic and mean arterial pressures in parturients with baseline PI > 3.5 suggest that these patients have lower baseline SVR and depleted autonomic resilience to hypotension compared to those with baseline PI ≤ 3.5. High BMI seems to be significantly associated with high baseline PI.

Arterial Spin Labeling (ASL) MRI in Evaluating Pancreatic Blood Perfusion in Subjects With Different Glucose Tolerances.

The pancreas plays a central role in type 2 diabetes mellitus (T2DM), and its blood flow is usually associated with insulin release demand. To noninvasively assess pancreatic blood flow (PBF) changes and modulation in people with different glucose tolerance following a glucose challenge using ASL MRI. Prospective. Fourteen prediabetes, 22 T2DM, and 40 normal. Pseudo-continuous ASL with a turbo gradient spin echo sequence at 3.0 T. All normal and subjects (diagnosed by oral glucose tolerance test) underwent ASL after fasting for at least 6 hours. The normal and prediabetes groups additionally had ASL scans at 5, 10, 15, 20, and 25 minutes following oral glucose (50 mL, 5%). PBF maps were generated from the ASL data and measured at body and tail. The ability of baseline PBF (BL-PBF) of body, tail (BL-PBFtail), and their average to determine abnormal glucose tolerance and stage was assessed. ANOVA, Mann-Whitney U test, Kruskal-Wallis H test, paired sample t-test, intra-class correlation coefficient, repeated measures ANOVA, correlation analysis, receiver operating characteristic analysis, and logistic regression analysis. A P value <0.05 was considered significant. There were significant differences in BL-PBF among the three groups. The prediabetes group exhibited significantly lower PBF than the normal group at all time points; Both groups showed similar changing trends in PBF (peaking at the 15th minute and subsequently declining). The BL-PBFtail had the highest diagnostic performance when evaluating abnormal glucose tolerance or stage (area under the curves = 0.800, 0.584, respectively) and was an independent risk factor for glucose tolerance status. ASL can noninvasively assess changes in PBF among individuals with varying glucose tolerance and in response to glucose challenge, which could be linked to insulin release demand and might help characterize changes in pancreatic endocrine function. 2 TECHNICAL EFFICACY: Stage 1.

Hydrothermal synthesis of BCQD@g-C3N4 nanocomposites supporting environmental sustainability: Organic dye removal and bacterial inactivation

Various studies are being carried out on the removal of organic dyes and the production of antibacterial agents. In this study, boron-doped carbon quantum dot (BCQD) was synthesized by hydrothermal method, and BCQD@g-C3N4 nanocomposite structure was synthesized using graphitic carbon nitride (g-C3N4) as the support material. The photocatalytic activity of the synthesized nanocomposite against MO, RhB dyes, and Escherichia coli (E. coli) bacteria was investigated. The surface, morphology, molecular, and crystal properties of BCQD@g-C3N4 were investigated using characterization methods such as Transmission electron microscopy (TEM), Fourier Transform Infrared Spectroscopy (FTIR), Fluorescence (FL) spectrophotometer, and X-ray diffraction (XRD). As a result of TEM analysis, it was determined that the average particle size of BCQD was 5.1 ± 1.14 nm and showed a homogeneous distribution on 2D g-C3N4. In the XRD spectrum for BCQDs, the diffraction peak corresponding to the (002) amorphous carbon phase was observed at 21.65° In the PL spectrum of B-CQD@g-C3N4s, the emission value was observed at 458 nm. In the study conducted by taking advantage of the photocatalytic feature of BCQD@g-C3N4 nanocomposite, Rhodamine B (RhB) and Methyl orange (MO) were degraded by 65.58 % and 73.56 %, respectively, at the end of 120 min. Additionally, BCQD@g-C3N4 photocatalyst completely inhibited the growth of E. coli bacteria, which are frequently encountered in wastewater, at 90 minutes under sunlight. Escherichia coli (E. coli), which is frequently encountered in wastewater, BCQD@g-C3N4 completely prevented bacterial growth in the 90th minute under sunlight.

Effect of body position during weaning from total liquid ventilation in piglets

ObjectiveTo determine if change in body position improves oxygen requirements and respiratory mechanics during the transition from total liquid ventilation (TLV) to gas ventilation. MethodsFourteen piglets underwent TLV, followed by a 2-hour weaning period under conventional gas ventilation. Subjects were randomized to the experimental group (Rotating – R), that was in prone position between the 10th and 30th minute of weaning, or to the static control group (Supine – S). ResultsOxygenation index was lower in the R group at 30 minutes in prone position than that in the S group (1.9 [1.6; 2.8] vs 3.5 [3.1; 5.1], p = 0.001). This difference disappeared when subjects resumed the supine position (4.2 [3.8; 4.7] and 4.7 [3.8; 5.4], p = 0.4, for the R and S groups, respectively). The change in body position did not affect respiratory system compliance or inspiratory capacity. ConclusionProne position improved oxygenation during weaning from TLV. The effect disappeared once piglets returned to the supine position.

Does Monopolar Electrocautery Affect the Fetus during Cesarean Section?

Background and Objectives: This study aimed to assess the impact of monopolar electrocautery on the fetus during cesarean section. Materials and methods: A retrospective analysis was conducted with 552 patients delivered by cesarean section. Patients were grouped based on usage of monopolar electrocautery. In 272 patients, monopolar electrocautery was used to separate the tissues before the delivery. In 280 patients, no electrocautery was used. Newborn vital signs, Apgar scores, umbilical cord blood parameters, newborn serum parameters collected within 6th postpartum hour, and rate of newborn intensive care unit admission were compared. Results: The 1st and 5th minute Apgar scores were significantly higher in the electrocautery group; however, this difference lost its significance at the 10th minute. The median newborn pulse rate (148 (7) vs. 146 (6) beats per minute, p = 0.026), umbilical cord blood pH, and partial oxygen pressure were significantly higher in the electrocautery group compared to the no-electrocautery group (7.34 ± 0.06 vs. 7.31 ± 0.06, p < 0.001, and 25.5 (14.77) vs. 23 (16.08) mmHg, p = 0.025, respectively). The median umbilical cord blood serum calcium level was 1.51 (0.64) mmol/L in the electrocautery group, which was significantly lower than 1.9 (0.82) mmol/L in the no-electrocautery group (p = 0.002). The incidence of hypoglycemia was significantly lower in the electrocautery group than in the no-electrocautery group (2.2% vs. 5.7%, p = 0.035). Conclusions: Monopolar electrocautery during cesarean section affects the fetus, but it is safe to use it. Electrocautery is independently associated with umbilical cord blood pH and calcium level. Electrocautery may be associated with a lower incidence of hypoglycemia.

Comparison of the effects of Aprepitant and Granisetron in preventing postoperative nausea and vomiting (PONV) in patients undergoing Laparoscopic Cholecystectomy: A double-blind, randomized, controlled study

Background: Postoperative nausea and vomiting (PONV) is one of the most common findings in the first 24 hours after surgery, occurring in 30% of all patients and up to 80% of high-risk patients. We compared aprepitant (a neurokinin-1 receptor antagonist) and granisetron in preventing PONV in patients who underwent laparoscopic cholecystectomy (LC). Methods: Sixty-one patients (aged 18-90) and the American Society of Anesthesiologists (ASA) I-II class who underwent LC under general anesthesia were enrolled in the study. Our study aimed to compare the incidence of PONV between 0-6, 6-12, and 6-24 hours postoperatively and the need for additional antiemetic requirements primarily and, secondly, detecting VAS scores and additional analgesic requirements for aprepitant and granisetron. Results: Our study observed similar PONV changes in both groups at 0-6 hours. A significantly lower VDS was observed in group A at 30-60 minutes compared to group G (p=0.10). There was no significant difference between groups at other intervals until the 120th minute. Between 6 and 12 hours, Group A had a lower VDS (Verbal Descriptive Scale) than Group G, but there was no statistically significant difference (P&gt;0.05). There was no significant difference between the groups regarding VAS scores, additional analgesic requirements, and adverse effects on patients (p&gt;0.05). Conclusion: We observed that aprepitant may be more effective than granisetron in preventing PONV and can be used safely in patients undergoing LC.

Allergen immunotherapy effectiveness in specific nasal reactivity of children with local allergic rhinitis.

Background.Allergen immunotherapy (AIT) is the only disease-modifying treatment in allergy. Its efficacy has been demonstrated in the treatment of Local Allergic Rhinitis (LAR) in adults. This study intends to evaluate the effectiveness of AIT in specific nasal reactivity of paediatric patients with LAR. Methods.Patients diagnosed with LAR to Dermatophagoides pteronyssinus (Dp) were submitted to subcutaneous AIT (SCIT) (depigmented-polymerized Dp allergen extracts) for 3 years. Nasal allergen challenge (NACs) with Dp extract were performed before and 3 years after AIT. NAC response was assessed with peak nasal inspiratory flow (PNIF) and symptom score of Lebel. NACs were considered positive when there was a flow decrease of ≥ 20% in PNIF and a score of symptoms ≥ 3 points. Demographic data and NAC results were analysed. Results.We included 32 paediatric patients (mean age 9.9±3.08 years, 18 female) and 10 adult patients, (mean age 30.4±12.2 years, 7 female). The symptom score obtained at the 1st minute, 5th minute, 15th minute and 30th minute in response to NAC, were reduced after AIT. The nasal inspiratory flow decrease induced by NAC was also reduced after AIT. This reduction in nasal reactivity was observed in paediatric and in adult patients, both with statistical significance. Conclusions.AIT induced a decrease in Dp-nasal specific reactivity in children with LAR. This decline of nasal response to allergen exposure, after AIT treatment, emphasis the interest of this therapeutic approach in LAR, even in paediatric patients.

Comparison of perinatal outcomes of women with gestational diabetes mellitus according to type of treatment for glycemic control

ObjectiveTo compare the perinatal outcomes of women with Gestational Diabetes Mellitus (GDM), between pregnant treated only with lifestyle changes and pregnant treated with insulin and lifestyle changes. MethodsProspective cohort study with follow-up of 64 women with GDM during the prenatal care and postpartum period until hospital discharge, divided into a control group (43) and an insulin group (21), with collection of sociodemographic, clinical, glycemic control and perinatal outcome data. Fetal macrosomia (≥ 4 Kg), or large-for-gestational-age newborns were considered the primary outcome of the research. ResultsPre-pregnancy BMI (31.2 ± 3.9 versus 28.8 ± 5.5), diastolic blood pressure (75 ± 8.7 versus 69 ± 6.9) and postprandial blood glucose (136.6 versus 115.4) ​​were higher in the insulin group, respectively. The control group had an average birth weight of 3058 g and an incidence of preterm birth of 11.6 %, while the insulin group had an average birth weight of 3203 g, with an incidence of preterm birth of 4.8 %. The majority of newborns had an adequate weight for their gestational age. Even all participants met glycemic goals, in the insulin group the Apgar score at the 5th minute and exclusive breastfeeding was lower, had 100 % of resuscitation cases, and a longer inpatient period. ConclusionThese data reinforce that even during prenatal care with lifestyle changes, newborns of women with GDM treated with insulin had worse outcomes, including clinical complications and less exclusive breastfeeding. It is important in prenatal care to identify neonates with risk for prevention and health promotion measures.

Comparison of the Cardiovascular Response to Sedation with Dexmedetomidine, Midazolam, and Etomidate in Phacoemulsification under Local Topical Anesthesia; A Double-Blind Randomized Controlled Clinical Trial

Background: The present study aimed to compare the cardiovascular response to sedation with dexmedetomidine, midazolam, and etomidate during phacoemulsification under local Topical anesthesia. Materials and Methods: In this double-blind randomized clinical trial, a total of 90 cataract surgery candidates undergoing phacoemulsification were selected and divided into three groups. The first group received 1 µg/kg dexmedetomidine over 10 minutes, followed by an infusion of dexmedetomidine at a rate of 0.5 µg/kg/h. The second group received 0.05 mg/kg midazolam, and the third group received 0.2 mg/kg slow IV etomidate. Hemodynamic parameters, sedation level, and adverse effects were recorded before anesthesia, during surgery, and during recovery. Results: The results of this study showed that in the 10th minute of surgery, the systolic blood pressure (SBP) in the etomidate group was significantly higher than the other groups P value = 0.029). The pulse rate (PR) in the etomidate group at the 15th minute during surgery, 10th, 20th, and 30th minute in the recovery period (mean 70.33 ± 10.34 bpm, 72.10 ± 10.18 bpm, 73.70 ± 10.18 bpm, and 75.03 ± 6.73 bpm, respectively) was significantly higher than the other two groups (P value &lt; 0.05). No adverse effects such as dizziness, restlessness, vomiting, or nausea were observed in the midazolam group. However, decreased heart rate was significantly higher in the dexmedetomidine group (26.7%) compared to the etomidate (3.3%) and midazolam (6.7%) groups (P value = 0.021). Conclusion: According to the results of this study, the sedation level achieved by dexmedetomidine, midazolam, and etomidate was similar. However, etomidate seemed to have a better effect on maintaining blood pressure and pulse rate compared to the other two drugs.