Narcotrend® Does Not Adequately Detect the Transition between Awareness and Unconsciousness in Surgical Patients

2004 ◽  
Vol 101 (5) ◽  
pp. 1105-1111 ◽  
Author(s):  
Gerhard Schneider ◽  
Eberhard F. Kochs ◽  
Bettina Horn ◽  
Matthias Kreuzer ◽  
Michael Ningler
Keyword(s):  
Elective Surgery ◽  
Surgical Patients ◽  
Dimensionless Number ◽  
Loss Of Consciousness ◽  
Time Points ◽  
Prediction Probability ◽  
Group 3 ◽  
To Receive ◽  
Narcotrend Index ◽  
Group 1

Background The Narcotrend index (MonitorTechnik, Bad Bramstedt, Germany) is a dimensionless number between 0 and 100 that is calculated from the electroencephalogram and inversely correlates with depth of hypnosis. The current study evaluates the capability of the Narcotrend to separate awareness from unconsciousness at the transition between these levels. Methods Electroencephalographic recordings of 40 unpremedicated patients undergoing elective surgery were analyzed. Patients were randomly assigned to receive (1) sevoflurane-remifentanil (</= 0.1 microg . kg . min), (2) sevoflurane-remifentanil (>/= 0.2 microg . kg . min), (3) propofol-remifentanil (</= 0.1 microg . kg . min), or (4) propofol-remifentanil (>/= 0.2 microg . kg . min). Remifentanil and sevoflurane or propofol were given until loss of consciousness. After tracheal intubation, propofol or sevoflurane was stopped until return of consciousness and then restarted to induce loss of consciousness. After surgery, drugs were discontinued. Narcotrend values at loss and return of consciousness were compared with each other, and anesthetic groups were compared. Prediction probability was calculated from values at the last command before and at loss and return of consciousness. Results At 105 of 316 analyzed time points, the Narcotrend did not calculate an index, and the closest calculated value was analyzed. No significant differences between loss and return of consciousness were found. In group 1, Narcotrend values were significantly higher than in group 3. Prediction probability was 0.501. Conclusions In these challenging data, the Narcotrend did not differentiate between awareness and unconsciousness. In addition, Narcotrend values were not independent from the anesthetic regimen.

Predictive Value of Minimal Residual Disease: Analysis By Flow-Cytometry in Children with Relapsed Acute Lymphoblastic Leukemia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 2494-2494
Author(s):  
Myriam Ruth Guitter ◽  
Jorge Gabriel Rossi ◽  
Elisa Sajaroff ◽  
Carolina Carrara ◽  
Pizzi Silvia ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Residual Disease ◽  
Lymphoblastic Leukemia ◽  
P Value ◽  
Time Points ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Group 1

Abstract Introduction: Despite the advances observed in the outcome of pediatric acute lymphoblastic leukemia (ALL) treatment during the last 20 years, relapse remains the most common cause of treatment failure in childhood ALL. Several factors have been associated to the prognosis of these patients; however, minimal residual disease (MRD) emerges as a relevant predictor of outcome. Objectives: The aims of this study were to assess MRD by flow-cytometry in relapsed ALL and to evaluate its prognostic impact as a predictor factor of outcome at the end of the induction therapy and prior to hematopoietic stem cell transplantation (HSCT). Patients and Methods: From Aug'10 to Jun'15, 123 ALL patients were treated at our center. MRD determination at least at two time-points during relapse treatment was a requirement for considering a patient eligible for the present study. Sixty-six cases were excluded due to the following causes: 10 patients died during induction, 2 died early in complete remission (CR), 29 did not respond to chemotherapy, in 13 patients MRD determination was not performed: 4 did not have clinical data available, 4 patients were Down Syndrome and 4 children received treatment for relapse in other centers. Thus, fifty-seven patients achieved CR and were evaluated for MRD at two time points. Of them, 56 patients belonged to S4 and S3 and 1 patient to S1 group as defined by the Berlin-Frankfurt-Münster stratification for relapsed ALL. MRD was analyzed by multiparametric flow-cytometry following ALL-IC 2009 guidelines. Negative MRD was defined as disclosing less than 0.1% of blasts. For this analysis, patients were stratified based on MRD levels at two different time points: after end of induction, before HSCT or at any other time point during the follow-up for patients who did not undergo HSCT. Three groups were defined: Group-1: negative at both time points (n= 23), Group-2: positive at 1 time point (n= 13) and Group-3: positive at both time points (n= 21). Patients who relapsed before receiving HSCT were considered Group-3. Twenty-five patients underwent HSCT: 13 of them from Group-1, 9 from Group-2 (2 had positive MRD previous to receive HSCT) and 3 patients from Group-3. HSCT was performed with matched familiar donor in 16 cases and matched unrelated donor in 9 cases. Results: The distribution of events according to receiving or not HSCT was: 5 died due to transplant related mortality (TRM), 9 relapsed after receiving HSCT and 16 during treatment with chemotherapy. With a median follow-up of 16 (range: 6-67) months, overall 3-year EFS probability (EFSp) (SE) was 32 (8)%. The 3-year EFSp was 75 (11)% for Group-1, 24 (14)% for Group-2 and 0% for Group-3 (p-value <0.00001). Comparing patients who did not receive HSCT vs. patients who did, EFSp (SE) was 32 (12)% and 29 (11)% respectively (p-value: non-significant). The EFSp (SE) according to MRD groups in patients who underwent HSCT was: Group-1: 53 (19)%, Group-2: 14 (13)% and 0% for Group-3 (p-value: 0.06). Conclusions: MRD quantification by flow-cytometry demonstrated to be a significant prognostic factor for relapsed ALL. Both, TRM and death in CR rates, were high and should be decreased by improving supportive measures. MRD determination by flow-cytometry in patients who underwent HSCT showed a trend to achieve a better EFSp, thus representing a relevant tool for stratifying relapsed ALL patients in order to achieve a better selection of patients to receive HSCT. Disclosures No relevant conflicts of interest to declare.

Effect of Chlorhexidine Cleansing of Umbilical Cord for Prevention of Infection

2018 ◽  
Vol 4 (2) ◽  
pp. 35-39
Author(s):  
Md Khairuzzaman ◽  
MA Mannan ◽  
Abdul Matin ◽  
Mst Monjuman Ara Sarker ◽  
Nihar Ranjan Sarker ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Controlled Trial ◽  
Care Group ◽  
Cord Care ◽  
Randomized Controlled ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Level Hospital ◽  
Group 1

Background: Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns.Objective: The aim of study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: This randomized controlled trial was carried out between April 2013 to July 2014 and 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2)  and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group.  The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]). Conclusion: Chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing neonates.Bangladesh Journal of Infectious Diseases 2017;4(2):35-39

scholarly journals A Proper Increasing in the Testosterone Level May Be Associated With Better Pregnancy Outcomes for Patients With Tubal or Male Infertility During in vitro Fertilization/Intracytoplasmic Sperm Injection

2021 ◽  
Vol 12 ◽  
Author(s):  
Zhiyan Chen ◽  
Duoduo Zhang ◽  
Zhengyi Sun ◽  
Qi Yu
Keyword(s):  
Male Infertility ◽  
Pregnancy Outcomes ◽  
Inflection Point ◽  
Upward Trend ◽  
Time Points ◽  
Inflection Points ◽  
Group 3 ◽  
The Relationship ◽  
Group 1

We aimed to investigate the relationship between testosterone (T) levels and pregnancy outcomes in patients with tubal or male infertility at different times during in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. Patients with tubal or male infertility and normal androgen levels undergoing IVF/ICSI were consecutively recruited. We performed a longitudinal analysis of T levels at three time points (i.e., T0: baseline, T1: trigger day, and T2: day after the trigger day) in three groups with different pregnancy outcomes (i.e., group 1: no pregnancy; group 2: clinical pregnancy but no live birth; and group 3: live birth) as repeated measurement data using linear mixed-effects models. We also plotted fitted curves depicting the relationship between T levels and a number of oocytes retrieved at different time points and identified the inflection points of the curves. In total, 3,012 patients were recruited. Groups 1 and 3 had improvements in T levels at the three time points. After refitting, the slope in group 3 was significantly higher than that in group 1 (P = 0.000). Curves that reflected the association between T levels and numbers of retrieved oocytes presented an upward trend before a certain inflection point, after which the curves had no obvious changes or fell with increasing T levels. The inflection points for T0, T1, and T2 were calculated as 0.45, 0.94, and 1.09, respectively. A faster upward trend in T levels might be associated with better pregnancy outcomes. Within a range lower than a T level inflection point, more oocytes and embryos could be obtained with increasing T levels.

scholarly journals COVID-19 and antibacterial therapy in the inpatient settings: to whom, when, why?

2021 ◽  
Vol 31 (6) ◽  
pp. 701-709
Author(s):  
Nina A. Karoli ◽  
Alena V. Aparkina ◽  
Elena V. Grigoryeva ◽  
Nadezhda A. Magdeeva ◽  
Natalia M. Nikitina ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Elective Surgery ◽  
Unintended Consequences ◽  
Hospitalized Patients ◽  
Fourth Generation ◽  
Treatment Regimens ◽  
Inpatient Settings ◽  
Group 2 ◽  
To Receive ◽  
Group 1

Although antibiotics (ABs) are ineffective against COVID-19, they are often prescribed to patients with the new coronavirus infection. Many of these prescriptions are uncalled for.The aim of the work is to assess the frequency of prescribing antibiotics to hospitalized patients with confirmed COVID-19, identify the most commonly prescribed ABs, and determine the significance of various biomarkers for the diagnosis of bacterial infection.Methods. A retrospective analysis of 190 inpatient cases with confirmed COVID-19 was carried out. The records of COVID-19 patients who were admitted to the intensive care unit were excluded from the analysis. Two groups were formed: 30 patients (group 1) with COVID-19, emergency or elective surgery, and exacerbation of chronic infectious diseases, and 160 patients (group 2) with manifestations of COVID-19 only.Results. ABs were prescribed to 189 patients upon admission to the hospital. The most frequently prescribed ABs included macrolides (63.5%), respiratory fluoroquinolones (49.7%), and third or fourth-generation cephalosporins (57.1%). ABs were administered starting from the first day of admission and until the discharge. The patients in group 2 were more often prescribed respiratory fluoroquinolones and, less often, III - IV generation cephalosporins. Moreover, macrolides were used in the treatment regimens of both groups. Longer administration of respiratory fluoroquinolones to patients in group 2 than patients in group 1 (p < 0,05) was noted. Group 2 also tended to receive longer therapy with macrolides. On admission, the patients with signs of bacterial infection had more significant leukocytosis with a neutrophilic shift, a more common increase in ESR of more than 20 mm/h and an increase in the level of procalcitonin > 0,5 ng/ml.Conclusion. ABs were administered to the overwhelming majority of hospitalized patients in the absence of clear therapeutic indications. The ABs are likely to have a minimal benefit as empirical treatment of COVID-19 and are associated with unintended consequences, including adverse effects and increased antibiotic resistance. According to our data, the most informative markers of a secondary bacterial infection in patients with COVID-19 are leukocytosis with a neutrophilic shift, an increase in ESR of more than 20 mm/h, and a procalcitonin level of more than 0,5 ng/ml.

scholarly journals Chlorhexidine Cleansing of the Umbilical Cord for Prevention of Umbilical Infection: A Hospital based Study in Bangladesh

2018 ◽  
Vol 42 (1) ◽  
pp. 4-8
Author(s):  
M Khairuzzaman ◽  
MA Rouf ◽  
MMA Sarker ◽  
I Hossain ◽  
A Matin ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Bacterial Colonization ◽  
Care Group ◽  
Risk Of Infection ◽  
Cord Care ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Level Hospital ◽  
Group 1

Background: The umbilical cord is an important site for bacterial colonization. A possible consequence of bacterial colonization is cord stump infection, a factor that can greatly increase morbidity and mortality for infants in developing countries. Chlorhexidine cleansing of the cord can reduce neonatal mortality among newborns infants in low-resource settings with high risk of infection. This objective of this study was to determine the effect of cord cleansing with chlorhexidine in reduction of umbilical infection among newborns in hospital settings.Methodology: Between April 2013 to July 2014, 510 newborns were randomly assigned within a tertiary level hospital in Bangladesh to receive 1 of 3 cord care regimens: single cord cleansing with 4% chlorhexidine(Group-1), multiple cord cleansing with 4% chlorhexidine (Group-2) and clean and dry cord care (Group-3 : control).Results: The risk of umbilical cord infection (omphalitis) was significantly reduced in both the single (Relative risk [RR] 0.15 [95% CI] 0.008-0.93) and multiple chlorhexidine cleansing group (RR 0.37 [95% CI] 0.04- 0.99) compared to the dry cord care group. The risk of omphalitis was not significantly different between multiple and single chlorhexidine cleansing group (RR 3.14 [0.13-76.54]).Conclusion: 4% chlorhexidine significantly reduce the risk of umbilical infection in both single and multiple cord cleansing groups as compared to clean and dry cord care group.Bangladesh J Child Health 2018; VOL 42 (1) :4-8

Evaluating Time to In-Hospital Venous Thromboembolism in Obese Patients

2019 ◽  
pp. 089719001984700
Author(s):  
B. Tate Cutshall ◽  
Alexandra W. Tatara ◽  
Navneet Upadhyay ◽  
Mobolaji Adeola ◽  
David Putney ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Surgical Patients ◽  
Obese Patients ◽  
Consensus Approach ◽  
Vte Prophylaxis ◽  
Pharmacologic Prophylaxis ◽  
Group 3 ◽  
Group 2 ◽  
Insight Into ◽  
Group 1

Background: Currently, no consensus approach exists for optimal venous thromboembolism (VTE) prophylaxis in obese (BMI ≥30 kg/m2) patients. Time to development of in-hospital VTE is not well studied. Objective: This study evaluates time to in-hospital VTE in obese patients. Methods: A single-center, retrospective study evaluated obese patients that developed an in-hospital VTE. Patients were categorized into 3 BMI groups: 30 to 34.9 (group 1), 35 to 39.9 (group 2), and ≥40 (group 3) kg/m2. The primary end point compared time to VTE between the groups. Results: A total of 246 patients were included, and time to VTE was similar between the groups, 8 (group 1) versus 8 (group 2) versus 9 days (group 3); P = .38. Secondary outcomes showed time to VTE was shorter in acute care versus ICU patients (7.5 vs 10 days; P = .01), nonsurgical versus surgical patients (6 vs 9 days; P = .004), and no prophylaxis versus mechanical plus pharmacologic prophylaxis (4.5 vs 9 days; P < .001). Conclusions: BMI category did not significantly impact time to in-hospital VTE. This study provides insight into the timing of in-hospital VTE in obese patients. The differences in prophylactic strategies highlight the importance of optimized prophylaxis.

Results of trimethoprim-sulfamethoxazole prophylaxis in ventriculostomy and shunting procedures

1985 ◽  
Vol 62 (5) ◽  
pp. 694-697 ◽  
Author(s):  
Göran C. Blomstedt
Keyword(s):  
Placebo Group ◽  
Infection Rates ◽  
Group 14 ◽  
Content Type ◽  
Group 4 ◽  
Antibiotic Group ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Group 1

✓ The author reports the results of a study to assess the effectiveness of a trimethoprim-sulfamethoxazole combination as prophylaxis in ventriculostomy or shunting operations. Between 1980 and 1983, 122 patients undergoing shunting procedures were randomly assigned to receive trimethoprim-sulfamethoxazole (Group 1, 62 cases) or a placebo (Group 2, 60 cases). The same regimen was followed at each operation, and the patients were followed for a minimum of 6 months. There was a higher infection rate in the placebo group (14 of 60 patients compared with 4 of 62 patients in the antibiotic group, p < 0.01). The antibiotic protected against early infections (nine of the 60 patients in Group 2 against none of the patients in Group 1), but not against late infections (four of the 62 in Group 1 compared with five of the 60 in Group 2). During the same period, 52 patients undergoing ventriculostomy only were also randomly assigned to receive trimethoprim-sulfamethoxazole (Group 3) or placebo (Group 4). There were no differences in the infection rates between these groups (one of 25 in Group 3 as against one of 27 in Group 4).

scholarly journals Shear Bond Strength of Brackets Bonded to Enamel with a Self-Etching Primer

2009 ◽  
Vol 79 (1) ◽  
pp. 133-137 ◽  
Author(s):  
Matheus Melo Pithon ◽  
Antonio Carlos de Oliveira Ruellas ◽  
Eduardo Franzotti Sant'Anna ◽  
Márlio Vinícius de Oliveira ◽  
Luiz Antônio Alves Bernardes
Keyword(s):  
Bond Strength ◽  
Shear Bond Strength ◽  
Orthodontic Brackets ◽  
Adhesive Properties ◽  
Time Points ◽  
Crosshead Speed ◽  
Adhesive Remnant Index ◽  
Significant Difference ◽  
Group 3 ◽  
Group 1

Abstract Objective: To evaluate bonding efficacy of activated Transbond Plus Self-Etching Primer (TPSEP) used at different time points with Transbond XT to bond metallic orthodontic brackets to bovine incisors. Materials and Methods: The inferior incisors of 210 bovines were randomly divided into seven groups (n = 30). TPSEPs were mixed, activated, and kept activated for 30 (group 30), 21 (group 21), 15 (group 15), 7 (group 7), 3 (group 3), or 1 (group 1) days before bonding, and in one group (group 0) TPSEP was used immediately after mixed. At day zero, incisors in each group were bonded in exactly the same way. After applying TPSEP, brackets were bonded with Transbond XT, according to the manufacturer's instructions. After 24 hours, shear bond strength (SBS) tests were performed for all samples at a crosshead speed of 0.5 mm/min, and the Adhesive Remnant Index was scored. Results: There were no significant differences between the SBS of groups 0, 1, 3, 7, and 15 (P &gt; .05) However, those groups had higher SBS (P &lt; .05) compared with groups 21 and 30. No significant difference (P &gt; .05) was observed between groups 21 and 30. Despite the decrease in SBS for groups 21 and 30, bond strength values were still satisfactory. Conclusion: After activation, the TPSEP mix can be stored for a period of 15 days without losing its adhesive properties.

scholarly journals Effect of Accelerated Aging on the Sorption and Solubility Percentages of Silicone Facial Prostheses

2021 ◽  
Author(s):  
Adhara Smith Nóbrega ◽  
Clóvis Lamartinede Moraes Melo Neto ◽  
Daniela Micheline dos Santos ◽  
André Pinheirode Magalhães Bertoz ◽  
André Luiz de MeloMoreno ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Accelerated Aging ◽  
Time Points ◽  
Tukey Test ◽  
Group 4 ◽  
Facial Prostheses ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Group 1

Abstract Objective This study aimed to evaluate the effect of accelerated aging on the sorption and solubility percentages of the MDX4-4210 and A-2186 silicones. Materials and Methods Two silicones (A-2186 and MDX4-4210) and three intrinsic pigments (bronze, black, and pink) were used in this study. Thus, six groups were created (n = 10): Group 1 = bronze MDX4-4210; Group 2 = black MDX4-4210; Group 3 = pink MDX4-4210; Group 4 = bronze A-2186; Group 5 = black A-2186; and Group 6 = pink A-2186. The dimensions of all samples were the same (45-mm diameter (ø) × 1-mm thickness). The samples were aged for a total of 1,008 hours. In this period of 1,008 hours of accelerated aging, the sorption and solubility percentages of each sample were calculated at three time points (252, 504, and 1,008 hours). Statistical Analysis Three-way analysis of variance (ANOVA) and the Tukey test were performed (α = 0.05). Result Accelerated aging can significantly increase the sorption and solubility percentages of the MDX4-4210 and A-2186 silicones.

Intergroup Rhabdomyosarcoma Study-IV: Results for Patients With Nonmetastatic Disease

2001 ◽  
Vol 19 (12) ◽  
pp. 3091-3102 ◽  
Author(s):  
William M. Crist ◽  
James R. Anderson ◽  
Jane L. Meza ◽  
Christopher Fryer ◽  
R. Beverly Raney ◽  
...  
Keyword(s):  
Stage I ◽  
Embryonal Tumors ◽  
Primary Tumor Site ◽  
Free Survival ◽  
Eyelid Tumors ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
To Receive ◽  
Group 1

PURPOSE: The study goal was to improve outcome in children with rhabdomyosarcoma by comparing risk-based regimens of surgery, radiotherapy (RT) and chemotherapy. PATIENTS AND METHODS: Eight hundred eighty-three previously untreated eligible patients with nonmetastatic rhabdomyosarcoma entered the Intergroup Rhabdomyosarcoma Study-IV (IRS-IV) (1991 to 1997) after surgery and were randomized treatment by primary tumor site, group (1 to 3), and stage (I to III). Failure-free survival (FFS) rates and survival were the end points used in comparisons between randomized groups and between patient subgroups treated on IRS-III and IRS-IV. Most patients were randomized to receive vincristine and dactinomycin (VA) and cyclophosphamide (VAC, n = 235), or VA and ifosfamide (VAI, n = 222), or vincristine, ifosfamide, and etoposide (VIE, n = 236). Patients with group 3 tumors were randomized to receive conventional RT (C-RT) versus hyperfractionated RT (HF-RT). RESULTS: Overall 3-year FFS and survival were 77% and 86%, respectively. Three-year FFS rates with VAC, VAI, and VIE were 75%, 77%, and 77%, respectively (P = .42). No significant difference in outcome was noted with HF-RT versus C-RT (P = .85 and P = .90, respectively). Overall, patients with embryonal tumors benefited from intensive three-drug chemotherapy in IRS-IV (3-year FFS, 83%). The improvement was seen for patients with stage I or stage II/III, group 1/2 disease, many of whom received VA chemotherapy on IRS-III. Patients with stage 2/3, group 3 disease had similar outcomes on IRS-III and IRS-IV. Three-year FFS for the nonrandomized patient subsets was 75% with renal abnormalities; 81% for paratesticular, group 1 cases; and 91% for group 1/2 orbit or eyelid tumors. Patients with paratesticular primaries had poorer outcomes if they were more than 10 years old (3-year FFS, 63% v 90%). Myelosuppression occurred in most patients, but toxic deaths occurred in less than 1%. CONCLUSION: VAC and VAI or VIE with surgery (with or without RT), are equally effective for patients with local or regional rhabdomyosarcoma and are more effective for embryonal tumors than therapies used previously. Younger patients with group 1 paratesticular embryonal tumors and all patients with group 1/2 orbit or eyelid tumors can usually be cured with VA chemotherapy along with postoperative RT for group 2 disease.

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