Fourth Hour Research Articles

Self-Reported Sleepiness after 2, 4, and 7 Consecutive Night Shifts and Recovery Days in Danish Police Officers.

Background: Night shift work often implies shorter sleep duration and this can lead to sleepiness, which has been associated with an increased risk of accidents and injuries. The aim is to study how the number of consecutive night shifts affects self-reported sleepiness. Participants and methods: The study was a quasi-experimental, within-subject crossover study with 73 police officers. Three work schedules of two, four, and seven consecutive night shifts followed by the same number of recovery days, i.e., days worked or days off, was performed by all participants. Sleepiness was self-reported using the Karolinska sleepiness scale (KSS) every fourth hour on the last night shift and the last recovery day in each sequence. Results: We observed differences in the level of sleepiness between recovery days and night shift days but no differences in the pattern of sleepiness levels on night shift days in the different work schedules. The highest levels of KSS were observed before bedtime (at 07:00 after a night shift and 23:00 on a recovery day). Conclusion: The number of consecutive night shifts did not affect the self-reported levels of self-reported sleepiness among Danish police officers.

The using potential of a new natural anesthetic agent on rainbow trout (Oncorhynchus mykiss): Chamomile oil (Matricaria chamomilla)

One of the management problems in aquaculture is the negative impact of operational factors on fish health and welfare. In order not to adversely affect fish welfare, various anesthetic agents are applied in routine aquaculture operations. Alternative extracts are used as anesthetic agents in addition to traditional agents, which will minimally affect fish health. In this study, the hematological, biochemical, oxidative and histopathological effects of chamomile oil on rainbow trout (Oncorhynchus mykiss) were evaluated as an herbal anesthetic. The focus is on the anesthetic effect of chamomile oil at concentrations of 100 μL/L, 150 μL/L and 200 μL/L and its physiological findings on fish after anesthesia. Recovery time was significantly longer for 200 μL/L, while induction time was longer for 100 μL/L. Hematological parameters generally showed an increasing trend until the eighth hour and decreased to normal levels again at the sixteenth hour. The gill histology of the fish treated with 100 μL/L chamomile oil contains low degradation similar to the control group. However, hyperplasia and epithelial lifting were observed especially in the 150 μL/L group, and additional hypertrophy and necrosis symptoms were observed in the 200 μL/L group. As antioxidant activity, catalase and glutathione peroxidase showed higher results in the 100 μL/L group compared to the other groups and similar to the control. Although cortisol decreased for all groups at the first moment after anesthesia, it increased to normal levels in the 150 and 200 μL/L groups at the fourth hour. In the 100 μL/L group, the cortisol level could not reach the control level even at the eighth hour. As a result, even though chamomile oil at a concentration of 100 μL/L causes a relatively high induction time, it has a lower adverse effect on fish health than other groups.

Evaluation of the effect of different block techniques on open-heart surgery in the postoperative period: a prospective observational study.

Open-heart surgery is associated with severe postoperative pain. Adequate analgesia after open-heart surgery improves patients' early postoperative recovery, extubation, ambulation and early discharge from hospital. Regional anaesthesia techniques are the new hope for adequate postoperative analgesia after cardiac surgery and are widely used for early pain management in the first six hours. A total of 100 patients with the American Society of Anesthesiologists physical status classification I-III, aged 18 years and over, undergoing open-heart surgery with sternotomy for coronary artery bypass grafting or valve replacement under general anaesthesia, were included in this study. For postoperative analgesia, 50 patients with pectoral nerve (PECS II) block and 50 with parasternal (PS) block were consecutively enrolled in one of the groups at the end of the surgery and compared in terms of sedation scores, ventilation duration, pain scores at rest after extubation, block duration, total morphine consumption and complications. The block duration in the PS group was statistically significantly higher than in the PECS II group (p = 0.001, p < 0.05, respectively). The visual analogue scale scores at rest in the fourth and sixth hours were statistically significantly higher in the PECS II group than in the PS group ( p = 0.001, p = 0.001, p < 0.01). Cumulative morphine consumption in the PECS II group was statistically significantly higher than in the PS group in the fourth, sixth, 12th and 24th hours ( p = 0.001, p = 0.001, p = 0.001, p = 0.001, p = 0.001, p < 0.01, respectively). PS block provided longer block duration with lower postoperative pain and sedation scores than the PECS II block, with lower cumulative morphine consumption.

Evaluation of Surgical Fear Level and Postoperative Consequences in Patients Undergoing Laparoscopic Sleeve Gastrectomy

Objective: This study aims to evaluate the relationship between surgical fear level and postoperative pain, nausea–vomiting, and sleep quality in patients undergoing laparoscopic sleeve gastrectomy. Methods: The data for the descriptive and cross-sectional study were collected using the Descriptive Information Form, Surgical Fear Questionnaire, Visual Analog Scale, Rhodes Index of Nausea Vomiting and Retching, and Richard-Campbell Sleep Questionnaire. The study was conducted with 105 patients. The extent of the relationship between the predictors was evaluated through stepwise multiple linear regression analysis. Results: Preoperative surgical fear was determined as an effective factor in the severity of pain and sleep quality at the postoperative fourth hour. Concerning the increase of the severity of pain at the 12th and 24th hours, body mass index and accompanying comorbidities, postoperative nausea–vomiting, presence of chronic disease among the complaints, and age were effective factors. Pre-hospitalization sleep quality and comorbidity status of the patients were determined as predictors of postoperative sleep quality. Conclusions: Surgical fear of the patients was determined to increase the fourth-hour pain severity and decrease postoperative sleep quality. Some characteristics of the patients were associated with an increase in postoperative pain and nausea–vomiting symptoms and a decrease in sleep quality.

Ethyl Acetate Fraction of Bixa orellana and Its Component Ellagic Acid Exert Antibacterial and Anti-Inflammatory Properties against Mycobacterium abscessus subsp. massiliense.

Mycobacterium abscessus subsp. massiliense (Mabs) causes chronic infections, which has led to the need for new antimycobacterial agents. In this study, we investigated the antimycobacterial and anti-inflammatory activities of the ethyl acetate fraction of Bixa orellana leaves (BoEA) and ellagic acid (ElAc). In silico analysis predicted that ElAc had low toxicity, was not mutagenic or carcinogenic, and had antimicrobial and anti-inflammatory activities. Apparently, ElAc can interact with COX2 and Dihydrofolate reductase (DHFR) enzymes, which could explain both activities. In vitro analysis showed that BoEA and ElAc exerted antimicrobial activity against Mabs (minimum inhibitory concentration of 1.56, 1.56 mg/mL and bactericidal concentration of 6.25, 3.12 mg/mL, respectively. Clarithromycin showed MIC and MBC of 1 and 6 µg/mL). Treatment with BoEA or ElAc increased survival of Tenebrio molitor larvae after lethal infection with Mabs and reduced carrageenan-induced paw edema in mice, around 40% of edema volume after the fourth hour, similarly to diclofenac. In conclusion, BoEA and ElAc exert antimicrobial effects against Mabs and have anti-inflammatory effects, making them potential sources of antimycobacterial drugs. The biological activities of ElAc may be due to its high binding affinities predicted for COX2 and DHFR enzymes.

Dynamics of Drying Turmeric Rhizomes (Curcuma longa L.) with Respect to Its Moisture, Color, Texture and Quality

Drying involves removing moisture from food. Therefore, to preserve the phenolic and bioactive compounds such as curcumin, dimethoxy curcumin and bisdemethoxi curcumin, etc., an efficient drying method is considered necessary. The primary drying methods are sun drying, hot air oven drying and fluidized bed drying. Traditional drying methods result in the loss of volatile oil (up to 25%) by evaporation and destruction of some light-sensitive oil constituents. Three methods of drying Turmeric with pretreatments boiled/unboiled and whole/sliced (2.5 cm long) were compared on physical and quality parameters. Texture analysis from sundry sliced boiled rhizomes achieved maximum peak force (45.40 kg), which was an indication of maximum uniform drying. Moisture content was strongly and significantly associated with drying time in different drying methods. Out of the three drying methods, in general, the sun drying showed a declining trend of L*, a* and b* values with drying time. Whereas a slower rate of decrease in L*, a* and b* values was predominant in the oven dry method. Interestingly, in the case of the fluidized method, almost static L*, a* and b* values were measured at 3 h of drying onwards after a declining trend of those values. In the case of sun and oven drying, the hue angle reached its peak at the fourth hour of drying, then gradually declined up to final drying. However, for fluidized bed drying, it had a continuous declining trend for other parameters such as chroma and total color change; there was a sharp decreasing trend for all throughout. Turmeric whole boiled dried in the sun produced the maximum curcumin (5.82%) and the sliced boiled ones produced the maximum oleoresin (8.10%), indicating good quality powdered product among all other drying treatments. Considering all the aspects, it is recommended that sun drying should be followed in post-harvest operations, as it produces a quality powder with comparatively more curcumin, despite its longer drying time.

Oxidative Status and Thiol/Disulfide Homeostasis Are Changed During 75 g Oral Glucose Tolerance Test over a Five-Hour Period

Background Oral glucose loading may affect oxidative status during oral glucose tolerance test (OGTT). We aimed to investigate how oxidant and antioxidant markers and thiol/disulfide parameters change during OGTT. Methods OGTT was performed to 42 volunteers who were considered risk of type 2 diabetes and were divided into three groups (normoglycemic, prediabetes, diabetes) according glucose levels during OGTT. Glucose, insulin, c-peptide, total antioxidant status (TAS), total oxidant status (TOS), total thiol and native thiol were investigated with auto-anaylzer for five-hours period. Results Decrease of TAS and increase of TOS levels began with the increase in glucose and insulin levels. The increase of TAS started at third hour and reached the highest levels at fifth hour. OSI levels were higher at fourth hour than fasting and first hours in normoglycemic and diabetes groups. In the prediabetic group, TAS were higher than the other groups, TOS peak was at the second hour (p < 0.05). Native thiol and total thiol levels showed variable course during OGTT, both parameters increased at the end of the process (p < 0.05). Disulfide levels showed an increase trend but it was not statistically different in normoglycemic and diabetes groups. In prediabetes group, second hour disulfide level was lower than fasting state and disulfide was significantly increased at third, fourth and fifth hours and fifth hour disulfide level was also higher than fasting. Conclusion Oxidative stress parameters and thiol/disulfide balance were found to deteriorate within five-hours after glucose loading in all groups. These results indicates that oxidative stress occurs during OGTT.

MO1049: An Intradialytic Exercise at Start versus End of HD Session to Improve Strength with Non-Immersive Virtual Reality: A Randomized Controlled Trial

Abstract BACKGROUND AND AIMS Haemodialysis (HD) induces changes in addition to the kidney in other organs or systems so that patients usually present symptoms such as fatigue, generalized muscle weakness and low tolerance to exercise that result in functional impairment, decreased work capacity and dependence for activities of daily living. Intra-dialysis exercise programmes may help to partly reverse this situation. Exercise during the first 2-h of dialysis has proven to be safe. Our group showed that an acute session of virtual reality exercise during the last 30 min of HD was safe too. The aim of this study was to compare the impact of non-immersive virtual reality intra-dialysis during the first 2-h versus the last 2-h of dialysis on lower-limbs muscle strength. METHOD This was a randomized controlled trial. Participants were randomized in two groups: group A performed the exercise during the first and second hour of the HD session and group B performed it during the third and fourth hour. Strength was measured bilaterally with a hand-held Lafayette dynamometer in three movements of the lower limbs (hip flexion, hip abduction and plantar flexion) during the HD session. The intradialytic exercise consisted of a non-immersive virtual reality video game adapted to the dialysis session, in which the patient must catch treasures while avoiding bombs by moving the lower extremities, with a progressive duration of 25–45 min, over a 12-week period. RESULTS A total of 33 subjects were included in the analysis, 17 subjects (median age 71.8 years; 10 men) in group A and 16 subjects (median age 73.3 years, 9 men) in group B. At baseline the period analysed, there were no significant differences between the two groups in any of the movements analysed. The force analysed in the different movements showed that there was a significant increase in all the movements analysed in both groups. There was an increase in force in the movements of the lower right limb of 3.31 N in hip flexion, 2.01 N in hip abduction and 1.10 N in plantar flexion, as well as an increase in the outside in the lower left limb of 3.82 N in hip flexion, 2.47 N in hip abduction and 4.63 N in plantar flexion. There were no significant differences in the increase in strength in the movements analysed between both groups in the movements analysed after the 12-week period analysed. CONCLUSION There are no differences in the application of an intradialytic exercise at the beginning versus at the end of the HD session to improve strength with non-immersive virtual reality. An intradialytic exercise with non-immersive virtual reality improves limb strength in HD patients.

MO889: High Flux Dialyzer 2.6 M2 is Promising for Free Light Chains Removal in High Flux Hemodialysis and Hemodiafiltration

Abstract BACKGROUND AND AIMS Immunoglobulin light chains are classified as middle molecule uremic toxins and its removal through effective dialyzer is needed with less albumin loss. This study assessed the free light chains removal using dialyzer surface area (SA) 2.6m2 in high flux dialysis (HD) versus hemodiafiltration (HDF) and its relation to cumulative albumin loss. METHOD A cross-over study included 25 patients who underwent hemodialysis using dialyzer surface area 2.6 m2 in high flux HD followed by online post-dilution hemodiafiltration with washout period 2 weeks using high flux dialyzers (max 2.0 m2 SA). All patients were subjected to single session measurement of dialysate albumin every hour and pre-post dialysis Free light chains (FLC) kappa and Lambda by ELISA. RESULTS Dialyzer (SA) 2.6m2 showed significant reduction in post-dialysis kappa and lambda in comparison to pre-dialysis level in high flux hemodialysis and hemodiafiltration (P &amp;lt; 0.001). HDF showed higher kappa and lambda FLC reduction ratio (45.16 ± 6.53 ng/mL), (28.68 ± 4.36 ng/mL), respectively compared with high flux HD (29.52 ± 6.38 ng/mL), (19.48 ± 1.96 ng/mL), respectively (P &amp;lt; 0.001). HDF/HD fold change of kappa and lamda were (1.56 ± 0.23) and (1.48 ± 0.26), respectively. Patients on HDF dialysis had significant total albumin loss in dialysate [median (IQR) 2.47 (1.16) gm/dL] compared with high flux dialysis [median (IQR) 0.65 (0.64) gm/dL] with (P &amp;lt; 0.001). Maximum albumin loss in patients on HDF was in the first hour [median (IQR) 1.22 (0.59)] gm/dL with lower albumin loss in the next hours reaching median {0.17 (0.15) gm/dL} in the fourth hour. Trans-membrane pressure was positively correlated with total albumin loss in high flux hemodialysis and hemodiafiltration (r 0.443, p 0.027, r 0.745, P = 0.001), respectively. CONCLUSION High flux dialyzer 2.6 m2 (SA) is effective for free light chains removal especially with online post-dilution hemodiafiltration with acceptable albumin loss.

Evaluation of Nutritional Value and The Anti-Inflammatory Activity in Vitro and in Vivo of the Extract of a Recipe Based on Three Food Plants: Ceiba pentandra, Ipomea batatas and Spinacia oleraceae

Chronic diseases with an inflammatory component are the major cause of mortality in the world. The treatment of inflammation is generally based on chemical drugs. Nutritionists recommend the use of food plants that might have anti-inflammatory effects. So, the phenolic compounds, chemical composition, acute toxicity, in vitro and in vivo anti-inflammatory activities and pain-relieving activity of a recipe extract based on the leaves extract of three food plants (Ceiba pentandra, Ipomoea batatas and Spinacia oleracea) were evaluated. The results showed that the yield of extraction was 20.7 % and revealed the presence of polyphenols (821.6 mg/100 g) and flavonoids (99.8 mg/100 g). The chemical composition gave: proteins 0.023 %, lipids 0,011 %, ash 0.013 %, fibers 0.011 % and assimilables carbohydrates 0.026 %. The acute toxicity test did not cause any mortality, nor any sign of toxicity at the dose of 5000 mg/Kg/bw. In vitro anti-inflammatory test showed that the plants extract, at the concentrations of 150 and 250 µg/mL had an inhibitory effect, respectively of 65.63% and 86.97%. For in vivo anti-inflammatory test, at the doses of 400 and 800 mg/Kg/bw, the extract has an optimum inhibition of 79.95% and 53.62%, on a mice paw edema, at the fourth hour after injection. The pain test showed inhibitions of 94.74%; 98.25% and 100% at the respective doses of 300, 600 and 1200 mg/Kg/bw. The results therefore suggest that the recipe of the three food plants has an anti-inflammatory activity, certainly due to the presence of polyphenols and flavonoids.

The Age-Dependent Role of Th22, Tc22, and Tc17 Cells in the Severity of Pneumonia in COVID-19 Immunopathogenesis.

Coronavirus disease 2019 (COVID-19) has clinical manifestations ranging from mild symptoms to respiratory failure, septic shock, and multi-organ failure. Lymphocytes are divided into different subtypes based on their cytokine production pattern. In this study, we investigated the role of cytokine expressions of CD4+ T (T helper [Th]1, Th2, Th17, Th22) and CD8+ T cell subtypes (T cytotoxic [Tc]1, Tc2, Tc17, Tc22) in the pathogenesis of COVID-19. Peripheral blood mononuclear cells (PBMCs) were extracted with Ficoll by density gradient centrifugation from blood samples of 180 COVID-19 patients (children and adults) and 30 healthy controls. PBMCs were stimulated with PMA and Ionomycin and treated with Brefeldin A in the fourth hour, and a 10-colored monoclonal antibody panel was evaluated at the end of the sixth hour using flow cytometry. According to our findings, the numbers of Th22 (CD3+, CD4+, and interleukin [IL]-22+) and Tc22 (CD3+, CD8+, IL-22+) cells increased in adult patients regardless of the level of pneumonia (mild, severe, or symptom-free) as compared with healthy controls (p < 0.05). In addition, the number of Tc17 (CD3+, CD8+, and IL-17A+) cells increased in low pneumonia and severe pneumonia groups compared with the healthy controls (p < 0.05). Both IL-22 and IL-17A production decreased during a follow-up within 6 weeks of discharge. Our findings suggest that the increase in only IL-22 expressed Tc22 cells in the 0-12 age group with a general symptom-free course and higher levels of Th22 and Tc22 in uncomplicated adult cases may indicate the protective effect of IL-22. On the contrary, the association between the severity of pneumonia and the elevation of Tc17 cells in adults may reveal the damaging effect of IL-22 when it is co-expressed with IL-17.

In vitro, in vivo and in silico evaluation of the anti-inflammatory potential of Hyssopus officinalis L. subsp. aristatus (Godr.) Nyman (Lamiaceae)

Ethnopharmacological relevanceMedicinal properties of hyssop have been used in traditional medicine since ancient times, inter alia, in diseases/conditions with an inherent inflammatory process.Aim of the study: Accordingly, the aim of this study was to investigate the anti-inflammatory properties of hyssop herb preparations (essential oil and methanol extracts) in vivo, in vitro and in silico. Materials and methodsFor in vitro testing of essential oils and extracts of hyssop herb, the cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzyme assays were used. In vivo anti-inflammatory potential of the extracts (at doses of 50, 100 and 200 mg/kg) was assessed using the carrageenan-induced rat paw edema test. Molecular docking and dynamics were used for in silico testing of the inhibitory activity of chlorogenic (CA) and rosmarinic (RA) acids, as the dominant compounds in the tested methanol extracts against COX-1 and COX-2 enzymes. ResultsSignificant inhibitory activity was shown in the COX-2 test regarding extracts (essential oils did not exhibit any significant activity). Namely, all analyzed extracts, at a concentration of 20 μg/mL, showed a percentage of inhibition of COX-2 enzyme (54.04–63.04%), which did not indicate a statistically significant difference from the positive control of celecoxib (61.60%) at a concentration of 8.8 μM. In vivo testing showed that all methanol extracts of hyssop herb, at the highest test dose of 200 mg/kg in the third and fourth hours, after carrageenan administration, exhibited a statistically significant (p < 0.05) inhibitory effect on the increase in rat paw edema in relation to control. This activity is comparable or higher in relation to the reference substance, indomethacin, at a concentration of 8 mg/kg. The preliminary in silico results suggest that investigated compounds (RA and CA) showed better inhibitory activity against COX-1 and COX-2 than standard non-steroidal anti-inflammatory drug (NSAID), ibuprofen, as evident from the free binding energy (ΔGbind in kJ mol−1). The binding energies of the docked compounds to COX-1 and -2 were found to be in the range between −47.4 and −49.2 kJ mol−1. Ibuprofen, as the one NSAID, for the same receptors targets, showed remarkably higher binding energy (ΔGbind = −31.3 kJ mol−1 to COX-1, and ΔGbind = −30.9 kJ mol−1 to COX-2). ConclusionThe results obtained not only support the traditional use of hyssop herb in inflammatory conditions in folk medicine, but also open the door to and the need for further in vivo testing of extracts in order to examine the molecular mechanism of anti-inflammatory activity in living systems and possibly develop a new anti-inflammatory drug or supplement.

FLUCTUATIONS OF TOTAL ANTIOXIDANT CAPACITY (TAC) IN FRESH AND REFRIGERATED FRUIT JUICES BOUGHT IN BENIN CITY, NIGERIA

Fruit juices contain phenolic compounds and vitamin C which possess antioxidant capacity. A knowledge of the effect of refrigerated storage on the total antioxidant characteristics of citrus fruits is necessary. Total antioxidant capacities (TAC) of nine Nigerian fruits were collected from a local market. The pulp and seed free juices were obtained using a Gallenkamp juicer. The fresh fruit juices namely; Green Apple, carrot, Grape, Mango (Mangifera indica), ?Bush mango‘(Irvinga gabonesis), Orange, pawpaw, pineapple and watermelon were stored in plastic containers and refrigerated at 20C for 0, 15, 30,60,120, 240,and 360minutes. The juices were thereafter assayed for total antioxidant capacity during the timed intervals. Fresh Mango fruit juice had the highest TAC with a value of 76.62 ± 0.16mM Trolox Equil/L. Pawpaw and pineapple juices had the lowest value of 11.89±1.29 mM and 12.91± 1.05mM Trolox Equil/L respectively. The results showed general fluctuations in the TAC of all the fruit juices. These values fluctuated between 15 and 30minutes period and rose to a peak between thirty minutes to two hours, except for apple which peaked at the fourth hour. Thereafter a downward trend was observed in all the fruit juices. TAC decreased thereafter to values lower than that obtained at 0hr. There were no significant difference at p ? 0.05 between the values for TAC at 0 and 6hr for carrot, grape, apple and pineapple juices. Therefore these juices have the greatest storage stability and the smallest antioxidant capacity decrease. Watermelon and pawpaw juices have the lowest TAC and after 6hours of refrigerated storage, the values were significantly lowered. Fruit juices should be consumed within two hours of its preparation to benefit maximally from its antioxidant content and effect

Assessment of Procedural Pain in Patients with COVID-19 in the Intensive Care Unit

AimThe purpose of the study was to assess the level of procedural pain in patients treated in the COVID-19 intensive care unit, in a tertiary university hospital. MethodWe performed the procedural pain assessment of COVID-19 patients in this study, and 162 (93.6 %) of 173 hospitalized patients assessed during this period. While pain was assessed before, during, and at the 20th minute after endotracheal aspiration, wound care, and position change, which are procedural patient practices, the pain was assessed before, during, and up to the fourth hour after prone positioning, high-flow oxygen therapy (HFOT), and the non-invasive mechanical ventilation (NIMV) procedure. The Numerical Pain Scale was used for conscious patients in pain assessment, while the Behavioral Pain Scale and the Richmond Agitation-Sedation Scale were used for unconscious patients. ResultsPatients who underwent endotracheal aspiration, wound care, and positioning had higher pain levels during procedure than other time points. Patients in the prone position with HFOT and NIMV applied had the highest pain scores at fourth hour after procedure; this increase was statistically significant (p = .000, p < .05). ConclusionsThe study found that COVID-19 patients in the ICU had pain due to procedural practices and that the level of pain during the procedures was higher because endotracheal aspiration, wound care, and positioning were all short-term procedures. Moreover, prone positioning was found to be associated with pressure-related tissue damage, and patients' pain levels increased with the increasing duration of HFOT and NIMV procedure.

How to treat patients with acute respiratory failure? Conventional oxygen therapy versus high‐flow nasal cannula in the emergency department

Objective:To investigate whether high‐flow nasal cannula oxygen therapy could reduce the rate of endotracheal intubation and improve arterial blood gas values, vital signs, and clinical outcomes of patients with hypoxemic acute respiratory failure as compared with conventional oxygen therapy alone.Methods:This retrospective, observational study was performed in the 15‐month study period and included adult patients with tachypnea and hypoxemia, whose vital signs and arterial blood gas were monitored. The high‐flow nasal cannula oxygen group consisted of patients admitted to the emergency department with acute respiratory failure when high‐flow nasal cannula oxygen treatment was available in the hospital, while the conventional oxygen therapy group consisted of patients who have presented to the emergency department with acute respiratory failure in the absence of high‐flow nasal cannula oxygen device in the hospital. The primary outcome of the study was improvement in vital signs and arterial blood gas values within first and fourth hours of the treatment. The second outcome was the need for intubation in the emergency department, length of hospital stay, and hospital mortality.Results:The decrease in the pulse and respiratory rate of high‐flow nasal cannula oxygen–treated group was significantly greater than the conventional oxygen therapy group on the first and fourth hours of treatment (p &lt; 0.001). PaO2 values were significantly higher in the high‐flow nasal cannula oxygen group at the first and fourth hours of treatment (p ⩽ 0.001). Likewise, mean SaO2 levels of patients receiving high‐flow nasal cannula oxygen treatment was significantly higher than those of patients in the conventional oxygen therapy group (p = 0.006 at 1 h and p &lt; 0.001 at 4 h). In the hypercapnic patients, the decrease in PaCO2 and increase in pH and PaO2 values were significantly greater in high‐flow nasal cannula oxygen group (p &lt; 0.001). The difference between the groups regarding the need for invasive mechanical ventilation was not statistically significant (p = 0.179).Conclusion:High‐flow nasal cannula oxygen treatment has been associated with favorable effects in vital signs and arterial blood gas values in patients with acute respiratory failure. High‐flow nasal cannula oxygen might be considered as the first‐line therapy for patients with hypoxemic and/or hypercapnic acute respiratory failure.

Dialysis headache: characteristics, impact and cerebrovascular evaluation.

Headache is one of the most frequent symptoms that occur during hemodialysis sessions. Despite the high prevalence of dialysis headache, it has been little studied. To evaluate the characteristics, impact and factors associated with dialysis headache. The behavior of the cerebral vasculature was also compared between patients with and without dialysis headache. This was a cross-sectional study. Consecutive patients who underwent hemodialysis were assessed through a semi-structured questionnaire, the Headache Impact Test (HIT-6), the Hospital Anxiety and Depression Scale and the Short Form-36 Health Survey (SF-36). Transcranial Doppler ultrasonography was performed in the first and fourth hours of hemodialysis. A total of 100 patients were included; 49 of them had dialysis headache. Women (OR=5.04; 95%CI 1.95-13.04), younger individuals (OR=1.05; 95%CI 1.01-1.08), individuals with higher schooling levels (OR=3.86; 95%CI 1.4-10.7) and individuals who had spent longer times on dialysis programs (OR=0.99; 95%CI 0.98-1) had more dialysis headache (logistic regression). Individuals with dialysis headache had worse quality of life in the domains of pain and general state of health (56.9 versus 76.4, p=0.01; 49.7 versus 60.2, p=0.03, respectively). Dialysis headache was associated with significantly greater impact on life (OR=24.4; 95%CI 2.6-226.6; logistic regression). The pulsatility index (transcranial Doppler ultrasonography) was lower among patients with dialysis headache than among those without them. Dialysis headaches occur frequently and are associated with worse quality of life and patterns of cerebral vasodilatation.

Desorption of nutrients and flavor compounds formation during the cooking of bone soup

In order to identify the effects of varying cooking time on the quality of bone soup, the diversification of nutrient profiles and flavor compounds in bone soup prepared within 10 h' cooking was studied. The Kjeldahl method, inductively coupled plasma mass spectrometry (ICP-MS), automatic amino acid analyzer (AAA analyzer), high performance liquid chromatography (HPLC), solid phase microextraction-gas chromatography-mass spectrometry (SPME-GC-MS) were applied to determine the changes o f crude protein, minerals, free amino acids (FAAs), 5′-nucleotides, and volatile compounds in the soup, respectively. During the 10 h cooking, the concentration of nutrients and flavor compounds reached their maximum and then decreased, except for minerals, which continued to increase in concentration. 18 FAAs were identified in all samples, which were related with I-collagen hydrolysis. Taste FAAs contributed little to the flavor of soup. Bitter amino acids increased significantly (P < 0.05) and IMP + GMP reached maximum concentration at the seventh hour of cooking. The main flavor compounds of bone soup were aldehydes, which increased significantly (P < 0.05) during boiling. Samples taken at the fourth and fifth hours contained the richest profile of volatile flavor compounds. In general, for high-quality bone soup, cooking time should be limited to achieve an appropriate balance between nutrient dissolution and flavor formation. • Crude protein and FAAs had dissolution equilibrium within atmospheric cooking. • Minerals increased with the extension of cooking time. • IMP + GMP may enhance the aroma of soup to the utmost extent at 7th hour. • Long-time heating destroyed the diversity of flavor and taste compounds and led to the loss of volatile flavor compounds. • Content of nutrients and flavor compounds was low in pure bone soup.

A randomized clinical trial on the effect of foot reflexology performed in the fourth stage of labor on uterine afterpain\xa0

BackgroundUterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women.MethodsThis single-blind, randomized, clinical trial recruited 80 eligible pregnant women presenting to Allameh Bohlool Hospital in Gonabad and 17-Shahrivar Hospital in Mashhad, Iran, in 2019. In the first and second hours postpartum, the reflexology group received 10 min of general massage and specific reflexology massage on each foot on the uterine, pituitary, and solar plexus points. The control group received 10 min of general massage, and then rotational massage on a neutral point on the lateral side of the heel. The pain was measured every hour up to 4 h postpartum using a visual analogue scale. The collected data were analyzed in SPSS-16 software at a significance level of P < 0.05.ResultsThe median of the afterpain score in the first hour (P = 0.05) and second hour (P = 0.274) postpartum did not differ significantly between the two groups, but this score was lower in the reflexology group at the third hour (P < 0.001) and fourth hour (P < 0.001) postpartum. The mean total afterpain score in the 4 h postpartum was significantly lower in the reflexology group (P < 0.001).ConclusionThe results revealed that foot reflexology in the fourth stage of labor has positive effects on relief from uterine afterpain. Reflexology is therefore recommended as a measure to reduce postpartum uterine afterpains.

Early application of non-invasive ventilation for children with pulmonary edema after drowning.

The present study aimed to assess the efficacy of non-invasive ventilation (NIV) on the clinical course, oxygenation, need for invasive mechanical ventilation (IMV), and outcomes for children with pulmonary edema after drowning. We conducted a retrospective chart review. Children who were referred to the pediatric emergency department due to drowning-related pulmonary edema and underwent NIV between May 2014 and October 2020 were included. Demographics, vital signs, clinical findings, and results of laboratory and radiologic investigations were recorded. Patients were divided into six groups using the Szpilman classification system. The need for IMV, the need for pediatric intensive care unit admission, and the length of NIV treatment and stay in the pediatric intensive care unit were recorded for each patient. Twenty-five patients were enrolled. According to the Szpilman classification, 13 (52.0%) patients were evaluated as grade 3 and 12 (48.0%) as grade 4. All patients were treated with bi-level positive airway pressure in the spontaneous / timed mode. A significant increase in oxygen saturation (SpO₂) and SpO₂/fraction of inspired oxygen ratios was observed from the beginning of NIV treatment and this increase was also observed for the second and fourth hours. There was a decrease in respiratory rate at the fourth hour of NIV treatment. No patient subsequently deteriorated to require IMV. We have reported a favorable clinical course of drowning patients who underwent early use of NIV in the pediatric emergency department. Management of drowning patients with pulmonary edema by NIV with close follow-up can be successfully applied in selected cases.

Massive hemorrhage after percutaneous liver biopsy in a pediatric patient with graft-versus-host disease; a successful angiographic embolization

Most cases of bleeding that develop after percutaneous liver biopsies can be managed with follow-up and supportive treatment. In life-threatening situations, however, open surgery or minimally invasive methods are required. This case report describes the clinical course of an 11-year-old patient with a diagnosis of Wiskott-Aldrich syndrome who experienced a major hemorrhage following a percutaneous liver biopsy. Clinical findings, imaging, interventions, and results were evaluated. Allogeneic hematopoietic stem cell transplantation was performed without any problem. The patient's bilirubin level started to increase on the 20th day after transplantation. Profuse watery diarrhea started on the 24th day. Graft-versus-host disease of the gastrointestinal tract and liver was considered as his diarrhea continued to the 29th day. An ultrasound-guided Tru-cut® liver biopsy (Merit medical, South Jordan, UT, USA) was performed with an 18-gauge needle on the 52nd day after transplantation. In the fourth hour after the procedure, the general condition of the patient started to deteriorate. Active bleeding was detected in the patient with computed tomography, and he was hypotensive and tachycardic. The patient was urgently transferred to the angiography unit and a successful angiographic embolization was performed. Angiographic embolization is an intervention with high success rates in cases of bleeding where the patient is hemodynamically stable. However, it can also be successfully applied in selected patients who are hemodynamically unstable.