Clinical Pharmacology of Fentanyl in Infants and Children

Fentanyl is a systemic opioid related to the phenylpiperidines, it is used in anaesthetic practice and in analgesia and the analgesic effect is about 100 times higher than that of morphine. Fentanyl is highly lipid soluble, rapidly crosses the blood-brain-barrier, and fentanyl concentrations rapidly decline in plasma and cerebrospinal fluid. Fentanyl causes respiratory depression and decreases the heart rate through vagal activation. Fentanyl may be administered intravenously, orally, by transdermal, intranasal or by buccal application and the oral bioavailability is poor. In infants, fentanyl is given for short term use, sustained use, and during therapeutic hypothermia. In children, fentanyl is given intravenously, by transdermal application, or by buccal administration and the fentanyl dose varies with the child age and body-weight. Fentanyl has been found efficacy and safe in infants and children but it may induce adverse-effects and fentanyl causes different effects in infants and children. Following intravenous administration of fentanyl to infants and children, the fentanyl elimination half-life ranges from 208 to 1,266 min and the distribution volume ranges from 1.92 to 15.2 L/kg. Such variability is due to the wide variation of subject’s demographic characteristics. Fentanyl interacts with drugs, the treatment and trials with fentanyl have been studied in infants and children. Fentanyl freely crosses the human placenta and poorly migrates into the breast-milk. The aim of this study is to review fentanyl dosing, efficacy, safety, effects, adverse-effects, metabolism, pharmacokinetics, drug interaction, treatment, and trials in infants and children, and fentanyl placental transfer and migration into the breast-milk.

Clinical Pharmacology of Rocuronium in Infants and Children

The main clinical use of the neuromuscular blocking agents is an adjuvant in surgical anaesthesia to obtain relaxation of skeletal muscle, particularly of the abdominal wall, to facilitate surgical manipulations. Rocuronium can be used instead of suxamethonium to provide rapid muscle paralysis during tracheal intubation but the recovery is much slower. Rocuronium is administered intravenously to infants and children. In infants, rocuronium is administered at a dose of 450 µg/kg for providing muscle relaxation for laryngeal intubation. To provide sustained paralysis, rocuronium is given at a dose of 600 µg/kg. In children, the neuromuscular blockade is obtained with 600 µg/kg followed by an intravenous infusion of 150 µg/kg per hour. For assisted ventilation in intensive care, rocuronium is administered at a dose of 600 µg/kg followed by an intravenous infusion of 300 to 600 µg/kg per hour. The effects of rocuronium have been extensively studied in infants and children. Rocuronium is converted into 17-desacetyl rocuronium. The pharmacokinetics of rocuronium have been studied in infants and children and the mean residence time is 55.6 and 25.6 min (P-value < 0.01) in infant and children, respectively. Rocuronium interacts with drugs, the treatment of infants and children with rocuronium has been studied, and rocuronium poorly crosses the human placenta. The aim of this study is to review the published data on rocuronium dosing, pharmacokinetics, and treatment in infants and children, and rocuronium metabolism and transfer across the human placenta.

The Nature of Consciousness: A Channel of a Frequency Wavelength

This article attempts to theoretically outline the nature of consciousness in Paul C. Mocombe’s consciousness field theory (CFT). Mocombe posits that consciousness is a channel of; or on; a frequency wavelength; which is both local and nonlocal. According to Mocombe; consciousness; is tied to an emergent fifth force of nature with an elementary particle; psychion; that arises from beings (subjects of experience) experiencing superimposed and entangled worlds; with Schumann waves tied to the (nonlocal) absolute vacuum; which gives rise to local consciousness fields the phenomenal properties; qualia; of which emerge as psychons and psychions in brains.

Paradoxical Malignant Embolism, Brief Review

During gestation period the oxygenated maternal blood is transferred to the embryo via the placenta and umbilical cord into the right atrium. It is further transferred through an interatrial shunt to the left atrium, the Foramen Ovale, and distributed to the embryonic body. The foramen is closed after the birth, but remains occasionally patent, permitting embolization through a right to left shunt. This is transferring thrombi, fat, cement and bony spikes, air, and occasionally malignant tissue. This brief review is on the malignant embolization.

Satisfaction and Experience of Palliative Patients with 24/7 Hotline Service During the COVID-19 Pandemic in Saudi Arabia

Background: The COVID-19 pandemic prompted a number of shifts on healthcare. Conventional face-to-face visits were shifted during lockdown to virtual ones. Palliative care (PC) virtual visits have had high satisfaction rates, especially with patients in remote areas. Due to a number of factors, further studies are needed to develop tools that can be helpful and cost effective in improving patient’s quality of life. Objective: Our aim is to learn the main reasons palliative patients in Saudi Arabia sought help via calling the free 24/7 hotline and to discuss the hotline’s satisfaction and effectiveness in solving the palliative patient’s concerns during COVID-19. Methods: A cross-sectional sample analysis was obtained from 214 patients from different regions in Saudi Arabia. A total number of 843 calls were made to the 24/7 PC hotlines from the period of 17 April 2020 to 28 February 2021, shortly after COVID-19 pandemic began. The purpose of the call, the caller's relationship to the patient, the status of the complaint, and the satisfaction rate were collected at the end of the call through a voluntary phone survey. Results: The primary reasons that palliative patients called the hotline were: 30% for medication refills, (n=247), 24.7% for medical complaints, (n=205), 15.8% were for booking a new appointment (n=131). Patients themselves accounted for 27.8% of the callers and patient’s sons/daughters accounted for 51.3%. 85% of patients said that their issue had been resolved by the end of the call and 89% of our sample were happy with the service provided through the hotline. Conclusion: The 24/7 hotline service for PC patients in Saudi Arabia was successful in its application and resulted in a high level of satisfaction among a wide sample of participants. The main reasons palliative patients reached out were to request medication refills, seek assistance with a medical complaint, and to book a new appointment. Our hotline service effectively solved 85% of patients' issues.

The amphoteric cartilage surface tested in the pH Range from 2.0 to 9.0

Background: Phospholipids adsorbed to negatively-charged proteoglycan matrix form phospholipid (membrane), have negatively charged surface (-PO4-) and are hydrophilic. Strong adsorption and strong cohesion are necessary for phospholipids to provide a good lubricant. The surface energy of spherical lipid bilayers have "bell-curve" shaped has amphoteric character and lowest surface energy at a pH 7.4 ± 1 of the natural joint. Objectives: The amphoteric character of the natural surface of the articular cartilage was determined by measuring the surface energy of the model spherical bilayer lipid membrane. It was found that the friction (f) vs. pH 2.0 to 9.0 of the pair (cartilage/cartilage) has the amphoteric character by exposing "bell-curve" shaped with an isoelectric point (IEP). Methods: The friction coefficient (f) was measured with the sliding pin-on-disc tribotester the friction between two surfaces (cartilage/cartilage) pair. The method of interfacial tension measurements of the spherical lipid bilayer model vs the pH over the range 0.2 to 9.0 was used. Results: The dependence of friction coefficient between two cartilage surfaces on the pH over the range 2.0 to 9.0 is demonstrated by a “bell - curve” in Fig. 2(A). The surface energy of a model spherical bilayer lipid membrane vs. the pH has the character of a “bell - curve” with an (IEP) is shown in Fig. 2(B). Conclusion: The amphoteric effect on friction between the bovine cartilage/cartilage contacts has been found to be highly sensitive to the pH of an aqueous solution. In this paper we demonstrate experimentally that the pH sensitivity of cartilage to friction provides a novel concept in joint lubrication on charged surfaces. The change in friction was consistently related to the change of charge density of an amphoteric surface.

Clinical pharmacology of lorazepam in infants and children

Lorazepam is a benzodiazepine has antiepileptic activity; it may be administered intravenously, intramuscularly, orally, by intranasal or buccal application and following oral dosing it is well absorbed. In infants, the initial intravenous dose of lorazepam is 100 µg/kg and in children the initial oral and intravenous dose is 50 to 100 µg/kg and the dose varies according to the child age. Lorazepam has been found efficacy and safe in infants and children but it may induce adverse-effects. Lorazepam is a racemate and the R and S enantiomers are conjugated with glucuronic acid in human liver microsomes and the respective Km and Vmax values are 29+8.9 and 36+10 µM and 7.4+1.9 and 10+3.8 pmol/min*mg. Lorazepam interacts with drugs and the interaction may affect the activity or metabolism of lorazepam. The pharmacokinetics of lorazepam have been studied in infants and children and in diseased children. In infants and children the elimination half-life is about 15 hours and it is about 24 hours and about 37 hours in children with severe malaria and convulsions following intravenous and intramuscular administration, respectively. The treatment and trials with lorazepam have been studied in infants and children. Lorazepam freely crosses the human placenta and poorly migrates into the breast-milk. The aim of this study is to review the published data on lorazepam dosing, efficacy and safety, adverse-effects, metabolism, interaction with drugs, pharmacokinetics, treatment and trials in infants and children and the lorazepam transfer across the human placenta and migration into the breast-milk.

Dimensional Meta-Analysis of Trust: Implications for Covid-19 Communication

The objective of this work is to review citizen confidence regarding government action in situations of risk and contingency such as the covid-19 coronavirus pandemic. A documentary, meta-analytic and retrospective study was carried out with a selection of sources indexed to international repositories, considering the period from 2010 to 2020, although the research design limited the results to the research scenario, suggesting the extension of the work towards the relationship between trust and microfinance in the framework of local development.

Van Lohuizen Syndrome, a Late-Diagnosed Case in an 18 Years-Old Female

Cutis Marmorata Telangiectatica Congenita is a very rare birth defect involving cutaneous blood vessels. Of unknown cause, uncertain pathophysiology, unclear epidemiology. Described as a localized, or generalized marbled skin appearance (cutis marmarota), in addition to the skin, it may involve any other body organs, with, or without a wide variety of associated congenital anomalies.Kato van Lohuizen described the first case in 1922. Since then, there have been less than 300 cases reported worldwide to date. We are adding one more case, and the first reported in Libya.

Healthy Living in Makassar’s Family Based on Thier Faith

Various aspects of human life are organized in Muslim community, including health problems. Islam highly upholds the health in which many people are deceived from such health. One of the efforts that can be done to maintain the health given by god is to implement clean and Healthy Living Behavior in families, schools and others. This research was conducted at Mosque of Antang, Makassar. This research was conducted using Cross Sectional design. The sample used as many as 40 respondents; data analysis used is univariate and bivariate with chi-square test. The results of statistical tests of Hand Washing Orders and defecation obtained a value of p Value of 0.000, and Smoking Prohibition obtained a value of p Value of 0.001, the test results showed that there is a relationship between Hand Washing Orders, defecation and Smoking Prohibition with Clean and Healthy Living Behavior, because the calculated value of P < α = 0.05. Based on the research, it can be concluded that Clean and Healthy Living Behavior of Applied Mosque Antang is in the good category. Where they are washing Their Hands, Make Latrines and without Smoking because of the encouragement of faith in their hearts, fear and obedience to the command of God and the magnitude of their love for the Messenger. Therefore, it is expected through this research that the People of Indonesia to further increase faith and following to god and love and practice of the Messenger of God in daily life.