Evaluation of the Development of Tolerance Following Frequent Administration of Propofol in Children Requiring Successive Sedation for Separate Procedures

OBJECTIVE Propofol is frequently used for outpatient sedation for pediatric patients, some of whom require multiple rounds of sedation for separate procedures within a short period. Anecdotal experience suggests that frequent use of propofol results in escalating doses; however, clinical evidence is unconvincing. This study was designed to evaluate if tolerance develops with frequent administration of propofol for children requiring multiple successive sedations. METHODS A retrospective chart review of patients requiring multiple doses of propofol for separate procedures from 2011 through 2019 was conducted. Cumulative propofol dose and induction dose were analyzed using a mixed model for patients requiring sedation for serial procedures. RESULTS Data from 24 different patients who required 3 or more sedations during the study period were analyzed. The number of sedations ranged from 3 to 28. The mean total propofol dose rate was 0.19 ± 0.14 mg/kg/min, and the mean induction dose was 3.2 ± 0.97 mg/kg. The total doses and induction doses were not statistically significantly different at different sedations (p = 0.089 and 0.180, respectively). There was a statistically significant decrease in the total dose as the time interval between 2 sedations increased (p < 0.001). CONCLUSIONS Repeated administrations of propofol at time intervals used in outpatient sedation do not lead to the development of tolerance. A small decrease per day interval may be significant when propofol is used more frequently (multiple times per day or as a continuous drip) in an ICU setting.

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Preliminary communication on the short-period oscillations of solar magnetic fields

Symposium - International Astronomical Union ◽

10.1017/s0074180900021574 ◽

1968 ◽

Vol 35 ◽

pp. 233-235

Author(s):

A. B. Severny

Keyword(s):

Magnetic Field ◽

Solar Magnetic Field ◽

Fixed Time ◽

Time Interval ◽

Solar Magnetic Fields ◽

Short Period ◽

Preliminary Communication ◽

Time Variations ◽

The Mean ◽

The Magnetic Field

With the image of the Sun held fixed, time variations of solar magnetic field were recorded simultaneously in two lines (λ5250 and λ6103) with the aid of double magnetograph (for the description see Severny, 1966, examples of such records are on Figures 1 and 2). The resolution was 2″.5 × 4″.5. The records in both lines λ5250 and λ6103 covering a time interval of about 1 hour show oscillations with the period ∼7·4min and amplitudes 10–20 gauss for moderately active region (full lines on the top of Figure 2). The oscillations of the magnetic field at both levels (the heights of λ 5250 and λ6103 differ by 260 km) are sometimes synchronous but now and then phase shift appears. For quiet regions near the centre of the disk the oscillations with the period ∼ 9·0 min and amplitudes less than 5 gauss are recorded and presented in Figure 1 (full line). These 7–9 min oscillations are probably sometimes damped or interrupted by more short-period fluctuations (with the mean period 80s) of smaller amplitude, but these last oscillations could be due to the fluctuations of seeing.

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Intralesional Tetracycline Injection, Pinch Technique, and Canthopexy for the Treatment of Severe Festoons: Preliminary Results

Aesthetic Surgery Journal Open Forum ◽

10.1093/asjof/ojab048 ◽

2021 ◽

Vol 4 ◽

Author(s):

Sergio Lessa ◽

João Pontello ◽

Deilton Duarte ◽

Diogo Lobão

Keyword(s):

Retrospective Chart Review ◽

Lower Eyelid ◽

Time Interval ◽

Level Of Evidence ◽

Preliminary Results ◽

Initial Injection ◽

Intralesional Injections ◽

The Mean ◽

Board Review

Abstract Background Many techniques have been presented for the treatment of lower eyelid festoons, but no singular technique has become dominant. Objectives The authors describe the safety and efficacy of intralesional tetracycline injection, the pinch technique, and canthopexy for the treatment of severe festoons. Methods Institutional board review approval was obtained, and a retrospective chart review was performed on 15 consecutive patients who had received 2% tetracycline injections to treat lower eyelid large festoons between February 2017 and February 2020. Three months after the last injection, a series of patients underwent the surgical procedure: pinch technique and canthopexy bilaterally. Results Clinical and photographic records were reviewed, and 12 patients were included in the analysis. Three patients did not return for follow-up after the injection series. Of the 12 patients, there were 3 male patients and 9 female patients, with an average age of 66.6 years. The mean volume injected in each festoon was 0.43 mL, and the mean follow-up was 313 days. A series of injections with a 3-month time interval were performed for patients with a partial response to the initial injection. There was no evidence of complications at the site of the injection. Three months after the last injection, these 12 patients underwent complementary surgical treatment, which included pinch resection and canthopexy. Conclusions These preliminary results suggest that intralesional injections of tetracycline 2% may offer a safe option to treat lower eyelid festoons. This noninvasive procedure represents adjunct benefits to complementary surgical therapy. Level of Evidence: 4

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the effects of resonance with Jupiter in the system of short-period comets

International Astronomical Union Colloquium ◽

10.1017/s0252921100033959 ◽

1974 ◽

Vol 22 ◽

pp. 193-203

Author(s):

L̆ubor Kresák

Keyword(s):

Structural Effects ◽

Order Resonance ◽

Mean Motion ◽

Short Period ◽

The Mean ◽

Compound Effect ◽

Low Order

AbstractStructural effects of the resonance with the mean motion of Jupiter on the system of short-period comets are discussed. The distribution of mean motions, determined from sets of consecutive perihelion passages of all known periodic comets, reveals a number of gaps associated with low-order resonance; most pronounced are those corresponding to the simplest commensurabilities of 5/2, 2/1, 5/3, 3/2, 1/1 and 1/2. The formation of the gaps is explained by a compound effect of five possible types of behaviour of the comets set into an approximate resonance, ranging from quick passages through the gap to temporary librations avoiding closer approaches to Jupiter. In addition to the comets of almost asteroidal appearance, librating with small amplitudes around the lower resonance ratios (Marsden, 1970b), there is an interesting group of faint diffuse comets librating in characteristic periods of about 200 years, with large amplitudes of about±8% in μ and almost±180° in σ, around the 2/1 resonance gap. This transient type of motion appears to be nearly as frequent as a circulating motion with period of revolution of less than one half that of Jupiter. The temporary members of this group are characteristic not only by their appearance but also by rather peculiar discovery conditions.

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Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

Journal of Nutrition and Metabolism ◽

10.1155/2016/5168978 ◽

2016 ◽

Vol 2016 ◽

pp. 1-9 ◽

Cited By ~ 12

Author(s):

Elizabeth K. Parker ◽

Sahrish S. Faruquie ◽

Gail Anderson ◽

Linette Gomes ◽

Andrew Kennedy ◽

...

Keyword(s):

Eating Disorders ◽

Weight Gain ◽

Statistical Significance ◽

Caloric Intake ◽

Tube Feeding ◽

Retrospective Chart Review ◽

Refeeding Syndrome ◽

Restrictive Eating ◽

Weight Restoration ◽

The Mean

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

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Can an amino acid mixture alleviate gastrointestinal symptoms in neuroendocrine tumor patients?

BMC Cancer ◽

10.1186/s12885-021-08315-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Aman Chauhan ◽

Satya Das ◽

Rachel Miller ◽

Laura Luque ◽

Samuel N. Cheuvront ◽

...

Keyword(s):

Amino Acid ◽

Neuroendocrine Tumor ◽

Gastrointestinal Symptoms ◽

Retrospective Chart Review ◽

Final Analysis ◽

Acid Mixture ◽

Tumor Patients ◽

Short Gut Syndrome ◽

Oral Rehydration ◽

The Mean

Abstract Background Neuroendocrine tumors, although relatively rare in incidence, are now the second most prevalent gastrointestinal neoplasm owing to indolent disease biology. A small but significant sub-group of neuroendocrine tumor patients suffer from diarrhea. This is usually secondary to carcinoid syndrome but can also be a result of short gut syndrome, bile acid excess or iatrogenic etiologies. Recently, an amino acid based oral rehydration solution (enterade® Advanced Oncology Formula) was found to have anti-diarrheal properties in preclinical models. Methods A retrospective chart review of all NET patients treated with enterade® AO was performed after IRB approval. Results Ninety-eight NET patients who had received enterade® AO at our clinic from May 2017 through June 2019 were included. Patients (N = 49 of 98) with follow up data on bowel movements (BMs) were included for final analysis. Eighty-four percent of patients (41/49) had fewer BMs after taking enterade® AO and 66% (27/41) reported more than 50% reduction in BM frequency. The mean number of daily BMs was 6.6 (range, 3–20) at baseline before initiation of therapy, while the mean number of BMs at 1 week time point post enterade® AO was 2.9 (range, 0–11). Conclusions Our retrospective observations are encouraging and support prospective validation with appropriate controls in NET patients. This is first published report of the potential anti-diarrheal activity of enterade® AO in NET patients.

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Correlation between fundus autofluorescence and visual function in patients with cone-rod dystrophy

Scientific Reports ◽

10.1038/s41598-021-81597-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Satoru Kanda ◽

Takumi Hara ◽

Ryosuke Fujino ◽

Keiko Azuma ◽

Hirotsugu Soga ◽

...

Keyword(s):

Visual Field ◽

Significant Relationship ◽

Fundus Autofluorescence ◽

Univariate Analysis ◽

Retrospective Chart Review ◽

Mean Deviation ◽

Wide Field ◽

The Mean ◽

The Relationship ◽

Field Imaging

AbstractThis study aimed to investigate the relationship between autofluorescence (AF) signal measured with ultra-wide field imaging and visual functions in patients with cone-rod dystrophy (CORD). A retrospective chart review was performed for CORD patients. We performed the visual field test and fundus autofluorescence (FAF) measurement and visualized retinal structures with optical coherence tomography (OCT) on the same day. Using binarised FAF images, we identified a low FAF area ratio (LFAR: low FAF/30°). Relationships between age and logMAR visual acuity (VA), central retinal thickness (CRT), central choroidal thickness (CCT), mean deviation (MD) value, and LFAR were investigated. Thirty-seven eyes of 21 CORD patients (8 men and 13 women) were enrolled. The mean patient age was 49.8 years. LogMAR VA and MD were 0.52 ± 0.47 and − 17.91 ± 10.59 dB, respectively. There was a significant relationship between logMAR VA and MD (p = 0.001). LogMAR VA significantly correlated with CRT (p = 0.006) but not with other parameters. Conversely, univariate analysis suggested a significant relationship between MD and LFAR (p = 0.001). In the multivariate analysis, LFAR was significantly associated with MD (p = 0.002). In conclusion, it is useful to measure the low FAF area in patients with CORD. The AF measurement reflects the visual field deterioration but not VA in CORD.

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Visual outcome of endogenous endophthalmitis in Thailand

Scientific Reports ◽

10.1038/s41598-021-93730-7 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Preeyachan Lourthai ◽

Pitipol Choopong ◽

Dhanach Dhirachaikulpanich ◽

Kunravitch Soraprajum ◽

Warinyupa Pinitpuwadol ◽

...

Keyword(s):

Retrospective Chart Review ◽

Visual Outcome ◽

Post Treatment ◽

Endogenous Endophthalmitis ◽

Infectious Episode ◽

Hand Motion ◽

Phthisis Bulbi ◽

Causative Agents ◽

Corneal Decompensation ◽

The Mean

AbstractTo evaluate a 10-year visual outcome of endogenous endophthalmitis (EE) patients. A 10-year retrospective chart review of EE patients. Thirty-eight patients (40 eyes) were diagnosed with EE at the mean age of 42. Among the identifiable pathogens (71.1% culture positive), the causative agents were predominantly gram-negative bacteria (48.1%). The most common specie was Klebsiella pneumoniae (25.9%). About a quarter of the patients required surgical eye removal, and the remaining 45.7% had visual acuity (VA) worse than hand motion at one month after the infectious episode. The most common complication was ocular hypertension (52.5%). Poor initial VA was significantly associated with a worse visual outcome in the early post-treatment period (p 0.12, adjusted OR 10.20, 95% CI 1.65–62.96). Five patients continued to visit the clinic for at least ten years. One patient had gained his vision from hand motion to 6/7.5. Two patients had visual deterioration, one from corneal decompensation, and the other from chronic retinal re-detachment. Two patients developed phthisis bulbi, with either some VA perception of light or no light perception. Poor initial VA is the only prognostic factor of a poor early post-treatment visual outcome of EE.

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Are the First and Second Hip in Staged Bilateral Total Hip Arthroplasty Equal? A Hospital Adverse Event and Perioperative Risk Comparison

The Journal of Hip Surgery ◽

10.1055/s-0041-1729868 ◽

2021 ◽

Author(s):

Jesus M. Villa ◽

Tejbir S. Pannu ◽

Carlos A. Higuera ◽

Juan C. Suarez ◽

Preetesh D. Patel ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Adverse Events ◽

Hip Arthroplasty ◽

Retrospective Chart Review ◽

Consecutive Series ◽

Level Of Evidence ◽

Exact Test ◽

Total Hip ◽

Discharge Disposition ◽

The Mean

AbstractHospital adverse events remain a significant issue; even “minor events” may lead to increased costs. However, to the best of our knowledge, no previous investigation has compared perioperative events between the first and second hip in staged bilateral total hip arthroplasty (THA). In the current study, we perform such a comparison. A retrospective chart review was performed on a consecutive series of 172 patients (344 hips) who underwent staged bilateral THAs performed by two surgeons at a single institution (2010–2016). Based on chronological order of the staged arthroplasties, two groups were set apart: first-staged THA and second-staged THA. Baseline-demographics, length of stay (LOS), discharge disposition, hospital adverse events, and hospital transfusions were compared between groups. Statistical analyses were performed using independent t-tests, Fisher's exact test, and/or Pearson's chi-squared test. The mean time between staged surgeries was 465 days. There were no significant differences in baseline demographics between first-staged THA and second-staged THA groups (patients were their own controls). The mean LOS was significantly longer in the first-staged THA group than in the second (2.2 vs. 1.8 days; p < 0.001). Discharge (proportion) to a facility other than home was noticeably higher in the first-staged THA group, although not statistically significant (11.0 vs. 7.6%; p = 0.354). The rate of hospital adverse events in the first-staged THA group was almost twice that of the second (37.2 vs. 20.3%; p = 0.001). There were no significant differences in transfusion rates. However, these were consistently better in the second-staged THA group. When compared with the first THA, our findings suggest overall shorter LOS and fewer hospital adverse events following the second. Level of Evidence Level III.

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TEVAR versus open repair of blunt traumatic descending aortic injury in polytraumatic patients involved in motor vehicle accidents

The Cardiothoracic Surgeon ◽

10.1186/s43057-021-00040-9 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Imthiaz Manoly ◽

Mohamed El Tahan ◽

Maymoona Al Shuaibi ◽

Fatimah Adel ◽

Mohammed Al Harbi ◽

...

Keyword(s):

Blood Transfusion ◽

Hospital Stay ◽

Open Repair ◽

Motor Vehicle ◽

Aortic Injury ◽

Motor Vehicle Accidents ◽

Time Interval ◽

Vehicle Accidents ◽

Severity Scores ◽

The Mean

Abstract Background Thoracic endovascular aortic repair (TEVAR) is the standard-of-care for treating traumatic aortic injury (TAI). Few retrospective studies compared TEVAR to open repair in blunt traumatic aortic injury (BTAI). Our objectives were to compare the early outcomes of TEVAR for blunt traumatic descending aortic injury to open repair (OR) in polytraumatic patients involved in motor vehicle accidents (MVA). Results Between February 2005 and April 2017, 71 patients with TAI due to MVA presented to our institution. All patients with descending aortic injuries were considered for open repair (n = 41) or TEVAR (n = 30) if there was no contraindication. The primary outcome was mortality, and secondary outcomes were stroke, paraplegia, intensive care unit (ICU), and hospital stay. The mean age was 28.4 ± 10.1 years in the OR group and 33.3 ± 16.6 years in TEVAR-group (P = 0.13). The injury severity scores were 41 ± 10 in the OR group and 33 ± 17 in the TEVAR group (P = 0.03). Patients in the OR group underwent emergency repair with a mean time of 0.56 ± 0.18 days from arrival. The TEVAR group had a longer time interval between arrival and procedure (2.1 ± 1.7 days, P = 0.001). The OR group had more blood transfusion (24 (58.5%) vs. 8 (27.5%), P = 0.002), renal impairment (6 (14.6%) vs. 1 (5.50%), P = 0.23), and wound infection (21 (51.2%) vs. 3 (10%), P < 0.001). Three TEVAR patients had a perioperative stroke compared to two patients in the OR group (P = 0.64). There was no difference in the mean ICU (6 ± 8.9 vs. 5.3 ± 2.9 days; P = 0.1) or hospital stay (20.1 ± 12.3 vs. 20.1 ± 18.3, P = 0.62) between the two groups. There were four deaths in the OR group and none in the TEVAR group (P = 0.13). Conclusion The results of TEVAR were comparable with the open repair for traumatic aortic injury with good early postoperative outcomes. TEVAR repair could be associated with lower mortality, blood transfusion, and infective complications. However, the complexity of the injury and technical challenges were higher in the open group.

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Trend of Hospital Admission and Outcome Study of Patients Admitted in a Neurology Unit at a Tertiary Care Neuroscience Hospital in Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v4i2.38917 ◽

2018 ◽

Vol 4 (2) ◽

pp. 69-74

Author(s):

Md Tauhidul Islam Chowdhury ◽

Mohammad Shah Jahirul Hoque Choudhury ◽

KM Ahasan Ahmed ◽

Mohammad Sadekur Rahman Sarkar ◽

Md Abdullah Yusuf ◽

...

Keyword(s):

Neurological Disorders ◽

Neurological Diseases ◽

Tertiary Care ◽

Length Of Hospital Stay ◽

Retrospective Chart Review ◽

Total Death ◽

Neurological Patients ◽

Study Population ◽

The Mean ◽

Day By Day

Background: Neurological disorders is becoming a growing concern both for developed and developing countries. Magnitude of the problem is increasing day by day. Among all neurological disorders, stroke is the leading cause of morbidity and mortality globally.Objectives: The purpose of the study was to see the trend of admission of patients with neurological diseases and to study the outcome of patients at referral neurology hospital in Bangladesh.Methodology: This retrospective chart review was conducted in the blue unit of the Department of Neurology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from 1st January to 31st December 2016 for a period of one (01) year. All the admitted patients with both sexes were selected as study population. The outcome was observed among the study population.Result: A total number of 1044 patients were admitted during the study period. Majority of the patients were in the age group of the 41 to 50 years which was 417(39.9%) cases. Both male and female were in highest number in the month of May which was 63 and 48 cases respectively. The total death of the study population was 146(14.0%) cases. The mean length of hospital stay was 8.4±2.31 days.Conclusion: Middle aged male is the main bulk of the neurological patients, admitted in a referral neurology hospital in Bangladesh. Highest admission and mortality was observed in stroke patients.Journal of National Institute of Neurosciences Bangladesh, 2018;4(2): 69-74

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